This website is for individuals with acne on the face and upper body who may be interested in participating 
in our medical research study. The purpose of this medical research study is to evaluate the effectiveness 
and safety of an investigational cream medication for acne vulgaris occurring on the face and upper body, or 
torso.
This website is for individuals with acne on the face and upper body who may be interested in participating in our medical research study. The purpose of this medical research study is to evaluate the effectiveness and safety of an investigational cream medication for acne vulgaris occurring on the face and upper body, or torso.

This medical research study is for individuals 9 years of age and older. For individuals between age of 9 and 17, this questionnaire should be completed by the parent or guardian.

To see if you or your child might pre-qualify for this medical research study, please complete our confidential questionnaire below.

A medical research study, such as this one, is designed to answer important questions about the effectiveness and safety of new investigational medications by testing them on people. Before medications can be approved for public use, they must be tested in research studies.

Participating cities:
  • Alabama
    •  Mobile
  • Arkansas
    •  Rogers
  • California
    •  Sacramento
  • Florida
    •  Miami
    •  Miramar
  • Georgia
    •  Newnan
  • Kentucky
    •  Louisville
  • New Mexico
    •  Albuquerque
  • North Carolina
    •  High Point
  • Oregon
    •  Portland
  • Tennessee
    •  Knoxville
Send site to a friend or family member:
Fill out the form below to send a link to this site to a friend or family member.
Your name
Friend/Family member’s email address
* We do not record any information you submit.

About This Study

About Medical Research

Pre-Qualifying Questionnaire:
To see if you may qualify for this medical research study,
please complete this Pre-Qualifying Questionnaire.

If you are under the age of 18 and are interested in this research study, please have your parent or guardian complete this questionnaire.

Except for those under the age of 18, these questions are to be answered by the person who would be enrolled in the research study if they qualify.

As used in these questions, “you” or “your” refers to the person who would be enrolled in the research study if they qualify.

1. How did you hear about this research study?
2. Please enter your home or work zip code. This zip code will be used to locate a study center near you. Please provide the zip code that would be most convenient to you.
Enter 5-digit zip code
3. What is your date of birth?
Month
Day
Year ex. 1954
4. Are you male or female?
Male   Female  
5. Approximately how many non-inflammatory facial acne lesions do you currently have? Common names for non-inflammatory lesions include “whiteheads” and “blackheads.”
0-10
11-20
21-29
31-39
40 or more
Unsure
6. Approximately how many inflammatory facial acne lesions do you currently have? Inflammatory lesions include red blemishes or bumps on your face, which may be large or small, and includes what is commonly called a pimple or zit.
0-9
10-15
16-25
26-35
36 or more
Unsure
7. Approximately how many non-inflammatory acne lesions do you currently have on the shoulders, upper back and chest? Common names for non-inflammatory lesions include “whiteheads” and “blackheads.”
0-9
10-15
16-25
26-35
36 or more
Unsure
8. Approximately how many inflammatory acne lesions do you [does your child] currently have on the shoulders, upper back and chest? Inflammatory lesions include red blemishes or bumps that may be large or small, and includes what is commonly called a pimple or zit.
0-9
10-15
16-25
26-35
36 or more
Unsure
9. Has a physician or doctor ever told you that you have acne conglobate, acne fulminans, chloracne, or that your acne is caused by medication?
Yes   No   Unsure  
10. Do you work outdoors in conditions that expose you to the sun?
Yes   No   Unsure  
11. Will you agree to refrain from sunbathing, using a tanning booth or receiving phototherapy during the study?
Yes   No   Unsure  
12. Are you currently participating in a medical research study or have you participated in a medical research study in the last 30 days?
Yes   No   Unsure  
13. Do you have any planned hospitalizations or operations?
Yes   No  

By clicking you authorize us to proceed with the pre-screening process and to begin recording your answers. By clicking you also consent to the terms of the Privacy and Confidentiality Policy. Your name and contact information will not be associated with your answers unless you provide this information after you complete the questionnaire.



Privacy and Confidentiality Policy: If you pre-qualify for this research study, you will be given a choice to submit your contact information along with your answers to the preliminary questionnaire to a study clinic conducting this research study for further evaluation. If you make the choice to submit your contact information, your contact information will only be shared with those involved with the medical research study and will not be shared or provided to any other person or business not related to this particular research study. Except as noted above, your name and contact information will not be taken from you and your answers will remain confidential. We will not use your information for any purpose other than to screen you for potential participation in this research study. Your answers will be stored electronically and for auditing purposes any identifying information that you provide to us will remain stored for up to seven years even if you choose not to participate or are not eligible to participate in this research study. If you provide your or a friend’s/family member’s email address, the email address will not be provided to anyone other than the person to whom the email was sent as specified in this website. The person in charge of privacy for this website is the Privacy Officer, who may be contacted at 6207 Bee Cave Road, Suite 288, Austin, Texas 78746 or privacy@tprausa.com to make any updates to your information or to have your information removed.


Powered by The Patient Recruiting Agency ™ © TPRA, 2015