Intake Request

Tell us what kind of research information you want to review.

Complete the form below. Mobile number and SMS choices are optional.

Start here

Clinical inquiry form

Use this page to request general research information. The form is designed to collect only basic details needed for an initial inquiry.

Contact

6850 Coral Way
Miami, Florida 33155

305-363-7081
mytrial@veromednet.com

First Name

Last Name

EmailMobile Phone (optional)

Age Range

Gender

Area of InterestQuestions or Notes

General Account Notifications
By checking this box, I agree to receive account-related text updates from Vero Medical Network about my submitted intake information. Message and data rates may apply. Msg frequency varies. I can reply STOP to opt out or HELP for help. Consent is not required for services or participation, and my number will not be shared with third parties or affiliates.

Marketing
By checking this box, I agree to receive marketing text messages from Vero Medical Network about clinical research information and related opportunities. Message frequency may vary. Message and data rates may apply. I can reply HELP for assistance or STOP to cancel. Consent is not required for services or participation, and my number will not be shared with third parties or affiliates.

Terms & Privacy Acknowledgment
I acknowledge that I can review the Terms of Use and Privacy Policy. This acknowledgment is separate from SMS consent choices above.

Thank you, your information has been submitted.

Submitting this form does not enroll you in a clinical study. A study team, research site, or qualified medical professional must review eligibility details before participation decisions are made.