If you are interested in participating in one of our enrolling research studies, please call us at (561) 638-0956 or please fill out this form and you will be contacted by phone.

This form submittal is for study inquiry. Filling out this form does not automatically enroll you in a study.  A member of our DRA clinical team will contact you for a phone screening to determine your eligibility to participate in a study.

First Name & M.I. Last Name Email Sex M F Date of Birth Address City State Zip Day Phone Evening Phone Where did you hear  about us? (If other, please specify below) Please pull down to select source Newspaper Ad TV Ad Magazine Ad Radio Ad Internet Directory Other / Specify below Other Notification  source:       Please tell us which study you are interested in participating: (If not included here, please specify in comment box) --------- Please pull down to select -------- Arthritis Fibromyalgia Insomnia / Sleep Disorders Rheumatoid Arhritis -- IF OTHER, please select this option and specify in box below ------ Comments to DRA:     Would you like your name and contact information to be added to DRA's database to contact you for future studies? YES    NO