Medical History Survey

To include you in a suitable Clinical trial, we would like to have more information about your medical history. Either tick your conditions below or you can tell us By completing this survey, we will be able to determine if there are a suitable study currently at JOHESE. Your details will be added to a database and you will be contacted in future should a suitable study for your condition starts in Centurion.bout your Medical history in the field below.

We will keep your data confidential.

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