Participate Links Participate in a Study FORE & Your Doctor Sign Up

Open to Bay Area residents only

Applicant Information
First Name:
Last Name:
Address Line 1
Address Line 2
City
Zip
Email address:
Phone (H):
Phone (W):
Medical Information
Date of Birth:
Menopause Status:	Premenopausal
What does this mean?	Perimenopausal
	Postmenopausal
	*If postmenopausal, date of last monthly period:
I have been diagnosed with osteoporosis:	Yes No
Medications Currently Used:	Check all those that apply
	Hormone Replacement Therapy (HRT)
	Fosamax, Actonel, Didronel
	Miacalcin (Calcitonin)
	Evista (Raloxifene)
	Tamoxifen (Nolvadex)
	None of the above
	Other current medications:
I am interested. Please contact me about possible participation in studies.

All study-related procedures & exams are performed under the supervision of
Risa Kagan, M.D. and Elliott N. Schwartz, M.D.
Foundation for Osteoporosis Research & Education
(510) 832-2663, ext 55
300 27th Street, Suite 103, Oakland, CA 94612