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  • * Note: Providing misleading information or intentionally withholding information may increase the likelihood of being found ineligible at the screening appointment. To ensure the integrity of our research, complete transparency is required. Any instance of misleading or withheld information may impact your eligibility for future Linear clinical trials.

  • 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
     - -
    2 digit day, 2 digit month, 4 digit year
  • Your preferred study duration for future studies (select all that apply):*
  • Please select your country of birth:*

  • *This medication is a topical application to the skin, we require specific skin types to be able to assess skin reactivity following study drug application. Please take a look at the image below to answer the next question*

  • Please select from the image pictured on the right, which of the following best matches your unexposed (before tanning) skin:*
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  • 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:

    • 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 30 days prior to Day 1 until at least 30 days after dosing?*

  • 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 until the 90 days after last study dose?*

  • 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 months?*
  • Have you used illicit drugs in the last 6 months or have you been diagnosed with a substance abuse disorder in the last 2 years?*

  • 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 1 month or have a vaccination scheduled?*
  • Do you have any history of gastrointestinal, neurologic, cardiovascular, hepatic, renal, digestive, urinary, psychiatric, respiratory, hematologic, endocrine, immunologic, pulmonary or skin disorders?*

  • Health and Medical History

  • Do you have any current acute skin conditions (e.g eczema, psoriasis, broken skin, wounds) or large tattoos, scars or excess hair at the dosing site (thigh)?*
  • Do you have any history of keloid scarring or hypertrophic scarring?*
  • Do you have any currently healing wounds, recent musculoskeletal injuries or healing fractures?*
  • Are you willing to avoid extensive sun exposure, phototherapy, or use of tanning salon or tanning products from 2 weeks prior to receiving the study drug until the end of the study?*
  • Have you donated any blood products or had significant blood loss in the last 3 months?*
  • Have you participated in any clinical study where you received an experimental medication or device within the last 30 days?*

  • Survey Questions

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