Study (NN-8687) Eligibility Questionnaire
Thank you for your interest in this clinical research study! To help us determine if you may be eligible, please answer all of the questions below. This should take less than 2 minutes. All questions require a YES or NO answer. Please answer each question honestly - there are no wrong answers. Your responses are confidential and will only be used to assess potential eligibility for this study.
First name
*
Middle name
Last name
*
Phone
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email
*
example@example.com
Are you 18 years of age or older?
*
Yes
No
Is your body max index (BMI) 27 or higher (If you are unsure, select YES and we will check this at your screening visit)?
*
Yes
No
Is it true that you DO NOT have diabetes?
*
Yes
No
Is it true that you have NOT TAKEN any GLP-1-based medication - including pills or injections such as Ozempic, Wegovy, Rybelsus, Mounjaro, Zepbound, Trulicity, or Foundayo - in the past 3 months?
*
Yes
No
Is it true that you have NEVER had bariatric surgery for the treatment of obesity?
*
Yes
No
Submit
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