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Submitted URL: https://liverstudyohio.com/
Effective URL: https://joinaresearchstudy.com/knee-replacement-survey/
Submission: On April 05 via api from US — Scanned from US
Effective URL: https://joinaresearchstudy.com/knee-replacement-survey/
Submission: On April 05 via api from US — Scanned from US
Form analysis 4 forms found in the DOM
GET https://joinaresearchstudy.com/
<form method="get" class="search-form navigation-search" action="https://joinaresearchstudy.com/">
<input type="search" class="search-field" value="" name="s" title="Search">
</form>Name: Knee Survey — POST
<form class="elementor-form" method="post" name="Knee Survey">
<input type="hidden" name="post_id" value="2873">
<input type="hidden" name="form_id" value="a20efd4">
<input type="hidden" name="referer_title" value="Knee Replacement Survey - Evolution Research Group">
<input type="hidden" name="queried_id" value="2873">
<div class="e-form__indicators e-form__indicators--type-number_text">
<div class="e-form__indicators__indicator e-form__indicators__indicator--state-active">
<div class="e-form__indicators__indicator__number e-form__indicators__indicator--shape-circle">1</div><label class="e-form__indicators__indicator__label">Contact Information</label>
</div>
<div class="e-form__indicators__indicator__separator"></div>
<div class="e-form__indicators__indicator e-form__indicators__indicator--state-inactive">
<div class="e-form__indicators__indicator__number e-form__indicators__indicator--shape-circle">2</div><label class="e-form__indicators__indicator__label">Personal Information</label>
</div>
<div class="e-form__indicators__indicator__separator"></div>
<div class="e-form__indicators__indicator e-form__indicators__indicator--state-inactive">
<div class="e-form__indicators__indicator__number e-form__indicators__indicator--shape-circle">3</div><label class="e-form__indicators__indicator__label">Health Information</label>
</div>
<div class="e-form__indicators__indicator__separator"></div>
<div class="e-form__indicators__indicator e-form__indicators__indicator--state-inactive">
<div class="e-form__indicators__indicator__number e-form__indicators__indicator--shape-circle">4</div><label class="e-form__indicators__indicator__label">Privacy</label>
</div>
</div>
<div class="elementor-form-fields-wrapper elementor-labels-above">
<div class="elementor-field-type-step elementor-column elementor-field-group-field_a88b4da elementor-col-100 e-form__step">
<div class="e-field-step elementor-hidden" data-label="Contact Information" data-previousbutton="" data-nextbutton="" data-iconurl="" data-iconlibrary="fas fa-star" data-icon=""></div>
<div class="elementor-field-type-text elementor-field-group elementor-column elementor-field-group-firstname elementor-col-50 elementor-field-required elementor-mark-required">
<label for="form-field-firstname" class="elementor-field-label"> First Name </label>
<input size="1" type="text" name="form_fields[firstname]" id="form-field-firstname" class="elementor-field elementor-size-md elementor-field-textual" placeholder="First Name" required="required" aria-required="true">
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<div class="elementor-field-type-text elementor-field-group elementor-column elementor-field-group-lastname elementor-col-50">
<label for="form-field-lastname" class="elementor-field-label"> Last Name </label>
<input size="1" type="text" name="form_fields[lastname]" id="form-field-lastname" class="elementor-field elementor-size-md elementor-field-textual" placeholder="Last Name">
</div>
<div class="elementor-field-type-email elementor-field-group elementor-column elementor-field-group-email elementor-col-33 elementor-field-required elementor-mark-required">
<label for="form-field-email" class="elementor-field-label"> Email </label>
<input size="1" type="email" name="form_fields[email]" id="form-field-email" class="elementor-field elementor-size-md elementor-field-textual" placeholder="Email" required="required" aria-required="true">
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<div class="elementor-field-type-text elementor-field-group elementor-column elementor-field-group-PrimaryPhone elementor-col-33 elementor-field-required elementor-mark-required">
<label for="form-field-PrimaryPhone" class="elementor-field-label"> Primary Phone </label>
<input size="1" type="text" name="form_fields[PrimaryPhone]" id="form-field-PrimaryPhone" class="elementor-field elementor-size-md elementor-field-textual" placeholder="Primary Phone" required="required" aria-required="true">
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<div class="elementor-field-type-text elementor-field-group elementor-column elementor-field-group-MobilePhone elementor-col-33">
<label for="form-field-MobilePhone" class="elementor-field-label"> Mobile Phone </label>
<input size="1" type="text" name="form_fields[MobilePhone]" id="form-field-MobilePhone" class="elementor-field elementor-size-md elementor-field-textual" placeholder="Mobile Phone">
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<label for="form-field-address" class="elementor-field-label"> Address </label>
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<div class="elementor-field-type-text elementor-field-group elementor-column elementor-field-group-apt elementor-col-33">
<label for="form-field-apt" class="elementor-field-label"> Apt. / Ste. </label>
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<div class="elementor-field-type-text elementor-field-group elementor-column elementor-field-group-city elementor-col-66 elementor-field-required elementor-mark-required">
<label for="form-field-city" class="elementor-field-label"> City </label>
<input size="1" type="text" name="form_fields[city]" id="form-field-city" class="elementor-field elementor-size-md elementor-field-textual" placeholder="City" required="required" aria-required="true">
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<div class="elementor-field-type-text elementor-field-group elementor-column elementor-field-group-zip elementor-col-33 elementor-field-required elementor-mark-required">
<label for="form-field-zip" class="elementor-field-label"> Zip Code </label>
<input size="1" type="text" name="form_fields[zip]" id="form-field-zip" class="elementor-field elementor-size-md elementor-field-textual" placeholder="Zip Code" required="required" aria-required="true">
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<div class="e-form__buttons elementor-column elementor-col-100">
<div class="elementor-field-group e-form__buttons__wrapper elementor-field-type-next"><button type="button" class="elementor-button elementor-size-lg e-form__buttons__wrapper__button e-form__buttons__wrapper__button-next">Next</button></div>
</div>
</div>
<div class="elementor-field-type-step elementor-column elementor-field-group-field_73b6639 elementor-col-100 e-form__step elementor-hidden">
<div class="e-field-step elementor-hidden" data-label="Personal Information" data-previousbutton="" data-nextbutton="" data-iconurl="" data-iconlibrary="fas fa-star" data-icon=""></div>
<div class="elementor-field-type-html elementor-field-group elementor-column elementor-field-group-field_03154aa elementor-col-100"> We need this information calculate your body mass index (BMI). </div>
<div class="elementor-field-type-number elementor-field-group elementor-column elementor-field-group-heightfeet elementor-col-20 elementor-field-required elementor-mark-required">
<label for="form-field-heightfeet" class="elementor-field-label"> Height (Feet) </label>
<input type="number" name="form_fields[heightfeet]" id="form-field-heightfeet" class="elementor-field elementor-size-md elementor-field-textual" placeholder="Height (Feet)" required="required" aria-required="true" min="" max="">
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<div class="elementor-field-type-number elementor-field-group elementor-column elementor-field-group-heightinches elementor-col-20 elementor-field-required elementor-mark-required">
<label for="form-field-heightinches" class="elementor-field-label"> Height (Inches) </label>
<input type="number" name="form_fields[heightinches]" id="form-field-heightinches" class="elementor-field elementor-size-md elementor-field-textual" placeholder="Height (Inches)" required="required" aria-required="true" min="" max="">
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<div class="elementor-field-type-number elementor-field-group elementor-column elementor-field-group-weight elementor-col-20 elementor-field-required elementor-mark-required">
<label for="form-field-weight" class="elementor-field-label"> Weight (lbs) </label>
<input type="number" name="form_fields[weight]" id="form-field-weight" class="elementor-field elementor-size-md elementor-field-textual" placeholder="Weight (lbs)" required="required" aria-required="true" min="" max="">
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<div class="elementor-field-type-text elementor-field-group elementor-column elementor-field-group-DOB elementor-col-25 elementor-field-required elementor-mark-required">
<label for="form-field-DOB" class="elementor-field-label"> Date of Birth </label>
<input size="1" type="text" name="form_fields[DOB]" id="form-field-DOB" class="elementor-field elementor-size-md elementor-field-textual" placeholder="MM/DD/YYYY" required="required" aria-required="true">
</div>
<div class="elementor-field-type-radio elementor-field-group elementor-column elementor-field-group-gender elementor-col-25 elementor-field-required elementor-mark-required">
<label for="form-field-gender" class="elementor-field-label"> Gender </label>
<div class="elementor-field-subgroup elementor-subgroup-inline"><span class="elementor-field-option"><input type="radio" value="Male" id="form-field-gender-0" name="form_fields[gender]" required="required" aria-required="true"> <label
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for="form-field-gender-1">Female</label></span><span class="elementor-field-option"><input type="radio" value="Other" id="form-field-gender-2" name="form_fields[gender]" required="required" aria-required="true"> <label
for="form-field-gender-2">Other</label></span></div>
</div>
<div class="elementor-field-type-checkbox elementor-field-group elementor-column elementor-field-group-race elementor-col-100">
<label for="form-field-race" class="elementor-field-label"> Please choose the race and/or ethnicity that describes yourself. Choose all that apply: </label>
<div class="elementor-field-subgroup "><span class="elementor-field-option"><input type="checkbox" value="Hispanic or Latino" id="form-field-race-0" name="form_fields[race][]"> <label for="form-field-race-0">Hispanic or
Latino</label></span><span class="elementor-field-option"><input type="checkbox" value="American Indian or Alaskan Native" id="form-field-race-1" name="form_fields[race][]"> <label for="form-field-race-1">American Indian or Alaskan
Native</label></span><span class="elementor-field-option"><input type="checkbox" value="Asian" id="form-field-race-2" name="form_fields[race][]"> <label for="form-field-race-2">Asian</label></span><span
class="elementor-field-option"><input type="checkbox" value="Black or African American" id="form-field-race-3" name="form_fields[race][]"> <label for="form-field-race-3">Black or African American</label></span><span
class="elementor-field-option"><input type="checkbox" value="Native Hawaiian or Other Pacific Islander" id="form-field-race-4" name="form_fields[race][]"> <label for="form-field-race-4">Native Hawaiian or Other Pacific
Islander</label></span><span class="elementor-field-option"><input type="checkbox" value="White" id="form-field-race-5" name="form_fields[race][]"> <label for="form-field-race-5">White</label></span><span
class="elementor-field-option"><input type="checkbox" value="Other" id="form-field-race-6" name="form_fields[race][]"> <label for="form-field-race-6">Other</label></span><span class="elementor-field-option"><input type="checkbox"
value="Prefer not to say" id="form-field-race-7" name="form_fields[race][]"> <label for="form-field-race-7">Prefer not to say</label></span></div>
</div>
<div class="e-form__buttons elementor-column elementor-col-100">
<div class="elementor-field-group e-form__buttons__wrapper elementor-field-type-previous"><button type="button"
class="elementor-button elementor-size-lg e-form__buttons__wrapper__button e-form__buttons__wrapper__button-previous">Previous</button></div>
<div class="elementor-field-group e-form__buttons__wrapper elementor-field-type-next"><button type="button" class="elementor-button elementor-size-lg e-form__buttons__wrapper__button e-form__buttons__wrapper__button-next">Next</button></div>
</div>
</div>
<div class="elementor-field-type-step elementor-column elementor-field-group-field_f9adb6a elementor-col-100 e-form__step elementor-hidden">
<div class="e-field-step elementor-hidden" data-label="Health Information" data-previousbutton="" data-nextbutton="" data-iconurl="" data-iconlibrary="fas fa-star" data-icon=""></div>
<div class="elementor-field-type-radio elementor-field-group elementor-column elementor-field-group-knee elementor-col-100 elementor-field-required elementor-mark-required">
<label for="form-field-knee" class="elementor-field-label"> Do you have knee pain? </label>
<div class="elementor-field-subgroup "><span class="elementor-field-option"><input type="radio" value="Yes" id="form-field-knee-0" name="form_fields[knee]" required="required" aria-required="true"> <label
for="form-field-knee-0">Yes</label></span><span class="elementor-field-option"><input type="radio" value="No" id="form-field-knee-1" name="form_fields[knee]" required="required" aria-required="true"> <label
for="form-field-knee-1">No</label></span></div>
</div>
<div class="elementor-field-type-radio elementor-field-group elementor-column elementor-field-group-diagnosed elementor-col-100 elementor-field-required elementor-mark-required">
<label for="form-field-diagnosed" class="elementor-field-label"> Have you been diagnosed with osteoarthritis of the knee by a doctor? </label>
<div class="elementor-field-subgroup elementor-subgroup-inline"><span class="elementor-field-option"><input type="radio" value="Yes" id="form-field-diagnosed-0" name="form_fields[diagnosed]" required="required" aria-required="true"> <label
for="form-field-diagnosed-0">Yes</label></span><span class="elementor-field-option"><input type="radio" value="No" id="form-field-diagnosed-1" name="form_fields[diagnosed]" required="required" aria-required="true"> <label
for="form-field-diagnosed-1">No</label></span></div>
</div>
<div class="elementor-field-type-radio elementor-field-group elementor-column elementor-field-group-field_bbe700a elementor-col-100 elementor-field-required elementor-mark-required">
<label for="form-field-field_bbe700a" class="elementor-field-label"> Have you had any injections in your knee? </label>
<div class="elementor-field-subgroup "><span class="elementor-field-option"><input type="radio" value="Yes" id="form-field-field_bbe700a-0" name="form_fields[field_bbe700a]" required="required" aria-required="true"> <label
for="form-field-field_bbe700a-0">Yes</label></span><span class="elementor-field-option"><input type="radio" value="No" id="form-field-field_bbe700a-1" name="form_fields[field_bbe700a]" required="required" aria-required="true"> <label
for="form-field-field_bbe700a-1">No</label></span></div>
</div>
<div class="e-form__buttons elementor-column elementor-col-100">
<div class="elementor-field-group e-form__buttons__wrapper elementor-field-type-previous"><button type="button"
class="elementor-button elementor-size-lg e-form__buttons__wrapper__button e-form__buttons__wrapper__button-previous">Previous</button></div>
<div class="elementor-field-group e-form__buttons__wrapper elementor-field-type-next"><button type="button" class="elementor-button elementor-size-lg e-form__buttons__wrapper__button e-form__buttons__wrapper__button-next">Next</button></div>
</div>
</div>
<div class="elementor-field-type-step elementor-column elementor-field-group-field_43e2a4a elementor-col-100 e-form__step elementor-hidden">
<div class="e-field-step elementor-hidden" data-label="Privacy" data-previousbutton="" data-nextbutton="" data-iconurl="" data-iconlibrary="fas fa-star" data-icon=""></div>
<div class="elementor-field-type-html elementor-field-group elementor-column elementor-field-group-field_88eb075 elementor-col-100">
<strong>Your privacy is important to us. Please confirm that you have reviewed our <a href="https://joinaresearchstudy.com/privacy-policy/" target="_BLANK">Privacy Policy</a> and agree to the Terms of Use.</strong>
</div>
<div class="elementor-field-type-acceptance elementor-field-group elementor-column elementor-field-group-acceptance elementor-col-100 elementor-field-required elementor-mark-required">
<div class="elementor-field-subgroup">
<span class="elementor-field-option">
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<label for="form-field-acceptance">Yes, I have reviewed the privacy policy and agree to terms of use</label> </span>
</div>
</div>
<div class="elementor-field-type-acceptance elementor-field-group elementor-column elementor-field-group-field_0a9bc57 elementor-col-100">
<div class="elementor-field-subgroup">
<span class="elementor-field-option">
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<label for="form-field-field_0a9bc57">Okay to receive text messages</label> </span>
</div>
</div>
<div class="elementor-field-type-recaptcha_v3 elementor-field-group elementor-column elementor-field-group-field_ad81994 elementor-col-100 recaptcha_v3-bottomleft">
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<div class="e-form__buttons elementor-column elementor-col-100">
<div class="elementor-field-group e-form__buttons__wrapper elementor-field-type-previous"><button type="button"
class="elementor-button elementor-size-lg e-form__buttons__wrapper__button e-form__buttons__wrapper__button-previous">Previous</button></div>
<div class="elementor-field-group elementor-field-type-submit e-form__buttons__wrapper">
<button type="submit" class="elementor-button elementor-size-lg e-form__buttons__wrapper__button">
<span>
<span class="elementor-align-icon-right elementor-button-icon">
<i aria-hidden="true" class="fas fa-paper-plane"></i> </span>
<span class="elementor-button-text">Send</span>
</span>
</button>
</div>
</div>
</div>
</div>
</form><form>
<div>
<div class="nf-before-form-content"><nf-section>
<div class="nf-form-fields-required">Fields marked with an <span class="ninja-forms-req-symbol">*</span> are required</div>
</nf-section></div>
<div class="nf-form-content ">
<div>
<div class="nf-mp-header">
<div>
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</form>Text Content
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KNEE REPLACEMENT SURVEY
PARTICIPATE IN KNEE REPLACEMENT RESEARCH
EXPLORE A RESEARCH STUDY OF AN INVESTIGATIONAL PAIN MEDICATION FOLLOWING A KNEE
REPLACEMENT.
COMPLETE THIS SHORT SURVEY TO SEE IF YOU QUALIFY
Please tell us about yourself so that we can find suitable study locations near
you. All the information you complete will remain private.
1
Contact Information
2
Personal Information
3
Health Information
4
Privacy
First Name
Last Name
Email
Primary Phone
Mobile Phone
Address
Apt. / Ste.
City
Zip Code
Next
We need this information calculate your body mass index (BMI).
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Please choose the race and/or ethnicity that describes yourself. Choose all that
apply:
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American Native Hawaiian or Other Pacific Islander White Other Prefer not to say
Previous
Next
Do you have knee pain?
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Have you been diagnosed with osteoarthritis of the knee by a doctor?
Yes No
Have you had any injections in your knee?
Yes No
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Privacy Policy and agree to the Terms of Use.
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Send
PARTICIPATE IN CLINICAL RESEARCH
VOLUNTEER FOR MEDICAL RESEARCH AT EVOLUTION RESEARCH GROUP TO LEARN MORE ABOUT
YOUR CONDITION, GAIN ACCESS TO NEW TREATMENTS AND MEDICATIONS, AND CONTRIBUTE TO
MEDICAL ADVANCEMENTS. STUDIES ARE NOW ENROLLING IN ARKANSAS. FLORIDA, OHIO, NEW
YORK, AND TEXAS. BROWSE ENROLLING STUDIES IN YOUR AREA AND APPLY TO SEE IF YOU
QUALIFY!
Join a Study!
CONTACT US
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Which Location? *
Please Select One... Little Rock, AR Rogers, AR Pasadena, CA San Diego, CA
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Message *
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Which Location?
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Stuart, FL Fort Myers, FL Hialeah, FL Rochester, NY Staten Island, NY Dayton, OH
San Antonio, TX
Message
Send
Brain Matters Research
(Delray Beach, FL & Stuart, FL)
Clinical Pharmacology of Miami
(Hialeah/Miami, FL)
Endeavor Clinical Trials
(San Antonio, TX)
Finger Lakes Clinical Research
(Rochester, NY)
HD Research
(Houston/Bellaire & Dallas/Carrollton, TX)
Midwest Clinical Research
(Dayton, OH)
Neuropsychiatric Research Center
(Fort Myers, FL)
Ohio Clinical Trials
(Columbus, OH)
Pacific Research Network
(San Diego, CA)
Richmond Behavioral Associates
(Staten Island, NY)
Woodland International Research Group
(Little Rock, AR)
Woodland Research Northwest
(Rogers, AR)
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