Streamline participant recruitment for your clinical trial with a structured eligibility screening form. This template collects demographics, current medications, inclusion and exclusion criteria confirmations, and contact consent — giving your study coordinator everything needed to pre-screen applicants before scheduling an in-person visit.
Clinical trial recruitment is one of the most resource-intensive parts of running any study. Phone pre-screens take 15–30 minutes per applicant, and many callers are immediately disqualified by a single exclusion criterion. A digital screening form solves this by letting applicants self-select through basic inclusion and exclusion criteria before the research team invests any staff time — dramatically improving the efficiency of your recruitment funnel.
This template covers the core fields that matter at the initial screen: demographics for population tracking, medical history for contraindication flagging, criteria confirmation checkboxes, and explicit contact consent. The inclusion and exclusion criteria sections use checkbox fields so applicants clearly affirm each item — making your pre-screen documentation stronger if questions arise later in the study.
formformform's unlimited submission model is especially well-suited for trials with large recruitment targets. Whether you're screening 50 applicants or 5,000, the form handles the volume without per-submission charges, and every entry is timestamped and stored securely for your records coordinator to review.
Pre-screens applicants for HbA1c range, current diabetes medications, and absence of renal impairment before scheduling in-person metabolic testing.
Collects cardiac history, implanted device status, and prior cardiac surgery history to assess eligibility for a wearable cardiac monitoring trial.
Gathers cancer diagnosis, staging, prior treatment lines, and ECOG performance status to determine candidacy for an investigational immunotherapy protocol.
Screens for depression severity scores, prior therapy history, current psychiatric medications, and absence of active suicidality for a CBT intervention trial.
Collects prior vaccination history, immune status, recent infections, and travel history to identify immunologically naive participants for a Phase II vaccine study.
Asks about polysomnography results, sleep diary data, apnea diagnosis, and current CPAP use to identify candidates for a novel insomnia pharmacotherapy study.
Collects child age, asthma diagnosis, current controller medication, and emergency department visit history through a parent-completed screening form.
Screens for cognitive assessment scores, family history of neurological conditions, and absence of MRI contraindications for an Alzheimer's biomarker study.
Pre-qualifies competitive athletes based on training volume, VO2max estimates, recent injuries, and supplement use for a sports nutrition intervention trial.
Assesses mobility aid use, fall history in the past year, grip strength self-report, and living situation to identify at-risk older adults for a balance intervention trial.
Screens pregnant participants for gestational age, supplement history, prior pregnancies, and dietary intake to assess eligibility for a prenatal nutrition study.
Collects pain duration, current analgesic use, prior interventional procedures, and pain scale scores to identify candidates for a transcranial stimulation protocol.
Click 'Use this template' to open the pre-built clinical trial screening form in the editor.
Update the study description paragraph with your specific trial name, NCT number, and eligibility overview.
Customize the inclusion and exclusion criteria checkboxes to match your exact protocol criteria.
Adjust the height and weight range validators in the number field settings to your study's BMI or anthropometric limits.
Add any study-specific questions such as prior treatments, comorbidities, or lifestyle factors relevant to your protocol.
Publish the form and distribute the link on ClinicalTrials.gov, patient advocacy websites, or your institution's recruitment portal.
applicants who understand what the trial is about self-select more accurately, reducing mismatched applications and wasted coordinator time.
medical jargon in exclusion criteria causes applicants to misinterpret their eligibility; use simple, direct language so the self-screen is accurate.
collecting an unambiguous 'yes, contact me' answer protects your organization and establishes a clear record of recruitment outreach consent.
many clinical trial coordinators prefer phone calls for follow-up; having the number captured at screening eliminates an extra data collection step.
limit the digital form to essential criteria and save detailed medical history and laboratory result review for the in-person screening visit.
add a note in the intro paragraph about how long it takes to hear back, reducing applicant follow-up calls to your coordinator.
formformform is a general-purpose form tool; it is not a covered entity under HIPAA and does not offer a BAA. For clinical trials that collect protected health information (PHI), consult your institution's compliance office about appropriate data handling procedures before using any third-party form tool.
Yes. In the form editor you can add any field type — radio, checkbox, number, text — to capture protocol-specific eligibility data such as prior treatment history, lab value thresholds, or comorbidity status.
formformform forms are submitted in one session. For a long screening form, consider breaking it into sections using the page break field, which allows stepwise completion without losing prior answers.
formformform sends an instant email notification to the form owner on every submission. You can configure the notification email to go to your study coordinator's inbox directly.
You can add a parental or guardian consent field and a parent/guardian name field to the form. For complex consent workflows, consult your IRB about appropriate documentation requirements beyond what a web form alone can capture.
Collect informed consent from research participants with full IRB-ready detail.
Collect participant data for academic studies with informed consent built in.
Collect structured research ethics applications for IRB review committees.
Log experimental measurements, sample details, and lab observations digitally.
Collect participant experience feedback after a research study session.
Free forever. No credit card required. Customize everything.
Use this template