Bioluminux | OCD Clinical Trial

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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

OCD Clinical Trial Study Eligibility Questionnaire

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 OCD 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

Your age:

Your height (if known):

Your weight (if known):

Do you have symptoms of OCD?

Yes

No

If yes, how long have you been experiencing OCD symptoms?

Are you currently taking any antidepressant?

Yes

No

If yes, which antidepressant are you taking and what is the dose?

Have you taken any other antidepressant or other type of medication for your OCD in the past?

Yes

No

If yes, please list it below:

Do you have a non-response or inadequate response to your current OCD medication?

Please list any other medications you are currently taking for other reasons:

Are you diagnosed with any of these conditions?

Bipolar disorder

Schizophrenia

Autism or ASD

Borderline Personality Disorder or EUPD

Body Dysmorphia disorder

Tourette's

None

Do you have history of:

Stroke

Seizure disorder

Traumatic Brain Injury

None

Do you have history of:

Psychosurgery

ECT or Deep Brain Stimulation (DBD)

None

Have you had eating disorder in the last 12 months?

Yes

No

Have you had a major depression or major anxiety disorder in the last 6 months?

Yes

No

Do you currently have active suicidal thoughts?

Yes

No

Have you had suicidal attempt in the last 12 months?

Yes

No

Do you have history of Type 1 or Type 2 Diabetes?

Yes

No

Have you participated in any other clinical trial in the last 90 days?

Yes

No

This is a clinical trial study that is trying a new treatment that is not yet approved. It is called Troriluzole, and it is to be in addition to your current medication. More details about the medication will be provided by our doctors if you are eligible for a Screening Visit. The study is for 3 months, and you will normally be expected to visit the clinic about 7 times. You will be reimbursed for your convenience, transportation and time taking to participate in the trial.

I have read the above

Your full name:

Email:

Phone:

Address:

Postcode

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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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