Severe Asthma Research Study - Clinical Hero Studies

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Living With Severe Asthma?

Complete this Study Form Below

Qualified participants will receive $100 per completed visit

Please complete this short form. This study is enrolling adolescents and adults with severe asthma (ages 12+). Qualified participants will receive $100 per completed visit. Thank you.

First Name of a Parent or Legally Authorized Representative (LAR) *

Email (parent/LAR) *

Cell Phone (parent/LAR) *

Has the applicant had at least two asthma attacks in the last year that resulted in hospitalization, for 24 or more hours each visit? OR required use of a steroid, such as prednisone? *

Yes, I meet these criteria
No, I do not meet these criteria
Please contact me regarding these requirements

Has the applicant used any Inhaled Corticosteroid plus long-acting asthma medication such as Advair, Breo Ellipta, Symbicort, or Trelegy, or other brands, for the last 12 months or greater? *

Yes, I meet these criteria
No, I do not meet these criteria
Please contact me regarding these requirements

Are you a current smoker, or have you been using nicotine or tobacco products in the last 6 months? *

No, I am not a current smoker, and have not been using nicotine or tobacco products in the last 6 months
Yes, I am either a current smoker, or I have been using nicotine or tobacco products in the last 6 months
Please contact me regarding these requirements

You agree that your information will be shared with Clinical Hero and Clinical Research of California, who may contact you via phone, text, and email to inform you of any available research studies. Clinical Hero will NOT sell your information to any third-party marketing firm. You agree to the terms of Clinical Hero's privacy policy and its terms and conditions. If you are contacted, Clinical Research of California will identify themselves. You can opt-out at any time.

I agree *

Check here to agree

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