LE250608 | The Resilience Study

This form should take about 3–5 minutes to complete. All information you provide will be kept confidential and used only to evaluate your eligibility for present or future research studies.
LE250608 - The Resilience Study
Name*

First NameLast Name
Email*
example@example.com
Birth Date*

DayMonthYear
Phone Number*
Please enter a valid phone number.
Biological Sex at Birth*

FemaleMale
Preferred Pronouns*

She/HerHe/HimThey/ThemOther
Date

DayMonthYear
Date
Age (automatically calculated)
How Tall are You?*
Height in centimetres
What is Your Current Weight?*
Weight in kilograms
BMI (automatically calculated)
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!
Channel
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Landing Page
Landing Page Group

Your health and medical history
Are you currently taking any medications, vitamins, or supplements, including stable prescription and over-the-counter options, or those used as needed (e.g., inhalers, iron supplements)?*

YesNo
Please provide details of the medication/s (e.g. name of the medicine, vitamin, supplement, date first prescribed, and what the medication is treating):
Have you taken any prescribed medications that you have started, stopped or changed in the last 30 days or do you plan to make any changes to your prescribed medications?*

YesNo
Please provide details of the medication/s (e.g. name of prescription medicine, date first prescribed, date stopped or if ongoing and what the medication is treating):
Do you have any current or past medical conditions? (This includes anything that required hospital stays, surgery, regular medication, or specialist visits for heart, liver, kidney, stomach, mental health, lung, blood, hormone, immune, or metabolic problems.)*

YesNo
Please provide more information (e.g. name of your medical condition, when the condition started, any treatment you had/are receiving):

LE250608 - The Resilience Study