Testimonials

This is what people are saying about their experience at the Northwest Clinical Research Center.

 

“I was experiencing some chronic pain and I wanted to be a part of something that was going to help people get some relief.”

Pat

 

“They made everything really easy…they came and picked me up….everyone was really friendly”

James


Questionnaire:


Do you have a history of any of the following?

 Seizure Disorder Stroke Head Injury Brain Tumor Cancer NONE

Do you have fewer than 3 bowel movements per week?
 Yes No

How often do you use:

NSAIDS:

OPIATES:

LAXATIVES:

What gender are you?
 Male Female

Are you over 18?
 Yes No

How did you hear about us?
 TV Radio Referral Flyer/Brochure Internet Search Web Advertisement Facebook Previous Patient

Please enter any questions or comments in the space below.

Name (First and Last):

Phone:

Email Address:

Are you a resident of Washington State?

Zip Code:

What is the best time to contact you?

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