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  • Nice to meet you, {name}!

    Your responses will be kept confidential between you and the Linear team in line with our privacy policy. Please continue to check your eligibility to participate in one of our studies in Perth, Western Australia!

  • Birth Date*
     - -
  • Biological Sex at Birth*
  • Preferred Pronouns*
  • Format: 0000000000.
  • Date
     - -
  • Preferred study duration (select all that apply):*

  • The combination of your weight and height determines your BMI (body-mass index)

    Each clinical trial has a "safe range" for participation based on BMI. A BMI that excludes you from a particular clinical trial may make you an ideal candidate for a different one. 

  • Contraception

  • Now, we'll ask you some basic questions about your medical history and lifestyle.

    Your health, privacy, and safety are of the utmost importance to Linear, and your accuracy in answering helps us determine your eligbility for this trial or others.

    We ask that you answer to the best of your ability as some health and lifestyle factors can affect the research outcomes and alter your risk profile for participation.

    Honest answers are important.

  • Are you currently pregnant or breastfeeding, or are you planning pregnancy within 12 months of the last study drug administration?

  • To protect your health and the integrity of our research, we require effective contraception options during the trial. This ensures the medication doesn't affect a potential pregnancy. 
    There are several reliable contraception methods to choose from. While these methods are effective, consulting your GP for personalised advice before screening is encouraged.

    Effective Options:

    • Barrier approach: The male partner(s) using a condom or the female using a birth control method (hormonal pill/implant, IUD, bilateral tubal occlusion etc.) OR same-sex partner(s).
    • Surgical: Sterilization (hysterectomy, bilateral salpingectomy, bilateral oophorectomy, bilateral tubal ligation, vasectomy) for you or your partner(s). 
    • Abstinence: Not sexually active, by choice, with anyone from the opposite sex for at least 2 months before and after the study.
    • Partner is post-menopausal (no menstrual periods for at least 1 year).

    For your information, these methods are not considered reliable during the study:

    • Relying solely on your partner's condom use
    • Withdrawal method of contraception
    • Emergency contraception ("morning after pill")
  • Are you willing to follow one of the following effective contraception methods from 30 days prior to the start of the trial and for a minimum of 30 days after completing the trial?*

  • To protect your health and the integrity of our research, we require effective contraception options during the trial. This ensures the medication doesn't affect a potential pregnancy. 
    There are several reliable contraception methods to choose from. While these methods are effective, consulting your GP for personalised advice before screening is encouraged.

    Effective Options:

    • Combined approach: The male partner(s) using a condom and the female using a birth control method (hormonal pill/implant, IUD, bilateral tubal occlusion etc.) OR same-sex partner(s).
    • Surgical: Sterilization (hysterectomy, bilateral salpingectomy, bilateral oophorectomy, bilateral tubal ligation, vasectomy) for you or your partner(s). 
    • Abstinence: Not sexually active, by choice, with anyone from the opposite sex for at least 2 months before and after the study.
    • Partner is post-menopausal (no menstrual periods for at least 1 year).

    For your information, these methods are not considered reliable during the study:

    • Relying solely on your partner's condom use
    • Withdrawal method of contraception
    • Emergency contraception ("morning after pill")
  • Are you willing to follow one of the following effective contraception methods from the start of screening and until completion of the last visit of the trial?*

  • Health and Medical History

  • Are you currently taking any medications, vitamins, or supplements, including prescription and over-the-counter options, or those used as needed (e.g., inhalers, iron supplements)?*
  • Have you taken prescribed medication that you have ceased in the last 12 months?*
  • Do you have any current medical conditions? This may include any conditions that previously required hospital admission, surgery, regular medication, regular blood tests or specialist appointments.*
  • Are you a smoker, or have you used tobacco or nicotine-containing products including vaping, shisha, patches and gum within the last 1 month?*
  • Have you used illicit drugs in the last 12 months or have you been diagnosed with a substance abuse disorder in the last 12 months?*

  • Health and Medical History

  • Do you have any history of HIV, Hepatitis B or Hepatitis C?*
  • Have you ever undergone surgery, or do you have planned surgery?*
  • Do you have any current allergies or intolerances, and have you had any allergies or intolerances in the past (i.e. during childhood?)*
  • Are you currently unwell, feeling ill or have a recent injury?
  • Do you have any mental health conditions or have you had a mental health condition in the last 12 months?

  • Health and Medical History

  • Have you previously had abnormal blood results from a blood test? For example; low iron or high bilirubin?*
  • Do you have any history of cancer (benign or malignant), or are you currently being investigated for this type of condition?*
  • Have you recently received any vaccines in the last 14 days or have a vaccination scheduled?*
  • Do you have any history of cardiovascular, neurologic, immune, endocrine, metabolic, renal, hepatic, haematological or pulmonary disease or disorder?*

  • Health and Medical History

  • Do you have any skin conditions, scarring, tattoos, birthmarks, etc on your abdomen, buttocks or loins?*
  • Do you have a past or present allergy to penicillin, beta-lactam antibiotics (cephalosporins, monobactam, carbapenems), lidocaine (local anaesthetic), soy or peanuts?*
  • Are you willing to avoid nicotine use during confinement periods (up to 8-10 hours)?*
  • Have you participated in any clinical study where you received an experimental medication or device within the last 30 days?*
  • I confirm that I have reviewed the time commitments for this study and have the availability to attend all required sessions, including all follow-up appointments. I understand that full participation is essential for the integrity of the research, and I agree to commit to the scheduled study timeline. I have no planned travel/potential work commitments in or outside of Perth that would prevent me from attending all the follow-up visits for this study.*

  • Survey Questions

  • What best fits your current lifestyle?
  • Should be Empty: