COVID Vaccine Booster questionnaire

Research
Current Studies
Patients
Meet The Team
Sponsors
FAQ
Contact
News

Get in touch

555-555-5555

mymail@mailservice.com

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

COVID 19 Vaccine Booster Clinical Trial - Register your interest

Bioluminux is committed to protecting the privacy of your personal information and rights in accordance with Data Protection Law. You have showed interest in the COVID-19 Vaccine Booster clinical trial study and this questionnaire is to assess your initial eligibility to enrol on the study. Full eligibility will be assessed after enrolling on the study. Access to your information is restricted to authorised staff within Bioluminux. We may share your data with your GP, the clinical trial Sponsor and 3rd party companies such as transportation services that you might need to visit the site.

I consent to the above

Full Name:

Email:

Phone:

Address:

Postcode:

Name of GP practice

This study is comparing two covid-19 booster vaccines to find out about it’s protection against Covid-19 infection. There is no placebo involved in this clinical trial study, all participants will receive an active treatment. The study will run for 1 year and you will be expected to visit the Research Centre in Milton Keynes about 6 – 7 times with telephone calls in between visits.

I have read the above

Your age

Have you taken at least 2 primary covid-19 vaccinations?

Yes

No

Have you taken 2 primary covid-19 vaccinations and 1 booster Vaccines?

Yes

No

Have you tested positive for SARS-COV-2 within the last 90 days?

Yes

No

Have you received covid-19 vaccine within the last 3 months?

Yes

No

Where did you hear about the study? (optional)

Thank you for registering your interest.

We will get back to you as soon as possible.

Oops, there was an error with your submission.

Please try again.

Call us Email us Find us

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

Terms of Use | Privacy & Cookie Policy | Trading Terms | Powered by Yell Business

© 2025. The content on this website is owned by us and our licensors. Do not copy any content (including images) without our consent.

Share by: