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Bioluminux Ltd

Research
Current Studies
Patients
Meet The Team
Sponsors
FAQ
Contact
News

Bioluminux Ltd
15 Diamond Court
Opal Drive
Fox Milne
Milton Keynes, MK15 0DU

COPD Clinical Trial Study - Initial eligibility assessment Questionnaire

Free Text

Kindly complete the brief questionnaire below, and a member of our team will get in touch with you.

Age

Do you have a diagnosis of COPD?

Yes

No

If yes, how long have you been diagnosed with COPD (in years)?

Smoking status:

Former smoker

Current smoker

Non-smoker

Do you use Nicotine or Vape?

Yes

No

Have you had a flare up (exacerbation) of your COPD in the last 1 year that required the use of rescue pack (Steriod and/or antibiotics)?

Yes

No

If Yes, how many flare ups of your COPD have you had in the last 1 year?

Was your GP aware of any flare ups?

Yes

No

When was your last flare up?

For any of the flare ups in the last 1 year, were you admitted to hospital?

Yes

No

Not applicable (I had no flare up in the last 1 year)

Did you visit Emergency Unit/Urgent Care for any of the flare ups in the last 1 year?

Yes

No

Not Applicable (I had no flare up in the last 1 year)

Are you currently on Oxygen therapy?

Yes

No

If yes, how many litres?

Which controller (main inhaler) therapy are you using for your COPD?

Are you using rescue inhaler (Blue inhaler - Ventolin/Salbutamol)?

Yes

No

Have you had recent chest xray or chest MRI in the last 6 months?

Yes

No

Do you also have a diagnosis of Asthma?

Yes

No

If you also have Asthma, is it still a problem?

Yes

No

Not applicable (No Asthma Diagnosis)

Which dates/days and times would you be available to book your screening visit at our clinic (weekdays only)?

Your full name:

Email:

Phone:

Address (including postcode):

Thank you! Your answers have been submitted.

Our team will get back to you as soon as possible.

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Contact us

Tel: +44 (0) 1908 985540

Mob: +44 (0) 7340774604

Fax: +44 (0) 1908 760671

Patient Services: clinicaltrials-uk@bioluminux.com

Admin: admin@bioluminux.com

Find us

Eastlake, Northfield Milton Keynes MK15 0DU United Kingdom

Business hours

Mon - Fri: 9:00 am - 5:00 pm
Sat - Sun: Closed

Registered Company Name: BIOLUMINUX LTD

Registered Address: 15 Diamond Court, Opal Drive, Fox Milne, Milton Keynes, MK15 0DU

Registered Company Number: 13155209

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