Clinical Trial Participation

If your adolescent is between the age of 13-17 and you are concerned that he/she may be suffering from fibromyalgia, feel free to complete the questionnaire or call our office to find out more information about our clinical trial.

Frequently asked questions about participating in a clinical trial:

Why are clinical trials necessary?

The United States Food and Drug Administration (FDA) require that all prescription medications be evaluated for safety and efficacy before they are marketed to the public.  So before a new medication can be made available, it must undergo extensive testing.  Clinical trials are part of this testing process.

Why are pediatric clinical studies conducted?

  • To see if a study medication or therapy is safe and effective for adolescent use
  • To find a new treatment and improve upon existing treatments for adolescents
  • To compare existing treatments
  • To determine the appropriate dosages for adolescents

What are some of the possible benefits of my child’s participation?

  • Your child will have access to potentially new study medications or therapies that are not otherwise available
  • Your child will receive study-related medical care for the condition being studied
  • You and your child will be helping other children be contributing to medical research and treatment advances

Do we need health insurance in order to participate in this study?

  • There is no monetary cost to you to participate in this study.  Nor do you have to pay for the study drug, visits, or procedures that are a part of the clinical trial. Therefore, no medical insurance is needed in order participate.

 

Some key questions to ask the clinical staff before your teen participates in a study

  • What is the purpose of this specific study?
  • Will my child receive any follow up care after the study has ended?
  • What are the obligations and expectations of me and my child as a volunteer?
  • How many visits to the clinic are required?
  • What are my other options if I choose not to have my child participate in this study?

 


Questionnaire:


Please let us know which of the following symptoms you’ve noticed your child has experienced.

 Fatigue Difficulty sleeping Constantly waking up tired Anxious or depressed Stomach or head aches Difficulty remembering Dizziness Restless leg while sleeping NONE

Has your child been treated for fibromyalgia before?
 Yes No

Is your child currently receiving treatment for fibromyalgia?
 Yes No

Does your child have a history of any of the following?

 Seizure Disorder Stroke Head Injury Brain Tumor Cancer NONE

What is the Child's Gender?
 Male Female

How old is your child?

Parent's Name (First and Last):

Child's Name (First and Last):

Phone:

Email Address:

Is the child a resident of Washington State?

Zip Code:

What is the best time to contact you?

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.

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