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  • Please confirm:*

  • 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 to conceive or breastfeed during 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. Please consult with your GP for personalised advice prior to screening. The decision to commence any form of contraception should be a decision between you and your GP

    Effective Options:

      • Combined approach: The female using a birth control method (hormonal pill/implant, IUD, etc.) and the male partner(s) using a condom OR same-sex partner(s).
      • Surgical: Sterilization (hysterectomy, bilateral salpingectomy, bilateral oophorectomy, tubal ligation, vasectomy) for you or your partner(s). 
      • Abstinence: Not sexually active, by choice, with anyone from the opposite sex during the study and for at least 2 months before and after the study.
      • 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")
      • Periodic abstinence
  • Are you willing to follow one of the following effective contraception methods from screening until completion of 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, etc.) OR same-sex partner(s).
    • Surgical: Sterilization (hysterectomy, bilateral salpingectomy, bilateral oophorectomy, tubal ligation, vasectomy) for you or your partner(s). 
    • Abstinence: Not sexually active, by choice, with anyone from the opposite sex during the study and 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")
    • Periodic abstinence
  • Are you willing to follow one of the following effective contraception methods while participating in the trial from screening until completion 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 2 months?*
  • Have you used illicit drugs in the last 6 months, IV recreational drugs in the last 5 years or have you been diagnosed with a substance abuse disorder in the last 5 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 30 days, or have a vaccination scheduled?*
  • Have you participated in any clinical study where you received an experimental medication or device within the last 30 days?*
  • Have you donated any blood products or had significant blood loss in the last 30 days?*

  • Health and Medical History

  • Have you had any infections requiring IV antibiotics in the last 6 months?*
  • Have you had a fever or a viral/bacterial infection in the last 2 weeks?*
  • Do you have any history of a life-threatening infection (e.g. meningitis)?*
  • Have you used any immunosuppressive medications in the last 4 months?*
  • As part of your PKD diagnosis, have you previously undergone genetic testing i.e. a saliva swab test?*
  • Are you able to provide a copy of these genetics results?*
  • Have you had any recent blood tests assessing your kidney function (e.g. creatinine levels, eGFR, urine testing) and are you able to provide the results of this testing?*
  • Are you able to provide the results of recent kidney imaging such as CT or MRI scans?*
  • Would you be willing to undergo an MRI of your abdomen for the study if you have not had one recently?*
  • Have you taken the medications tolvaptan and/or metformin within the last 30-37 days, and do you anticipate using it during the study period?*
  • Have you received, or anticipating to receive any of the following treatments for any renal condition?*
  • Do you have an active infection of the urinary tract (ie, kidney, bladder)?*
  • Have you experienced any complications of your polycystic disease (eg, cyst rupture or cyst infections) within the last 6 weeks?*
  • Do you have a history or presence of a condition associated with significant immunosuppression?*
  • Have you ever received a kidney transplant or do you have only one kidney?*
  • Aside from polycystic kidney disease, do you have any other diagnosed kidney conditions?*
  • Are you willing to avoid alcohol for 36 hours before check-in and 48 hours before any follow-up visits?*
  • Are you willing to avoid strenuous exercise 48 hours prior to check-in and 48 hours prior to any follow-up visits?*

  • Survey Questions

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