Committed to You
Chronic Obstructive Pulmonary Disease (COPD)

We are currently enrolling adults with COPD ages 40+ years in a research study of an investigational medication for Chronic Obstructive Pulmonary Disease (COPD).

Qualified participants will receive all study-related care and study medication at no cost, and may be compensated for time and travel.

To receive more information about this study, please take a moment to complete our online survey or you may call us directly at 817-281-4156.

Study volunteers are not required to complete this online survey in order to be considered for participation in this study. The purpose of this online survey is for us to collect your contact information as well as a brief medical history to help determine your eligibility.

All information provided will be considered confidential and will not be shared outside of Protenium Clinical Research.

Click here to view this study's dedicated website.
Name
Phone Number
Email
Have you been diagnosed with COPD?


Are you a current or past smoker?


Have you ever been diagnosed with asthma?


Have you participated in a pulmonary rehabilitation program in the past 6 months?


Do you currently use oxygen more than 15 hours a day?


Do you currently work the night shift?


Do you have any respiratory or cardiovascular conditions?


Do you have glaucoma?


Have you been diagnosed with cancer?
(Other than squamous cell skin or basal)


Have you participated in any clinical research trials within the last 12 months?


Please list all medications you are currently taking, especially those you take for COPD.

Copyright 2010 © Protenium Clinic Research