Diabetes Clinical Trial Initial Screening
Participant Information
Full Name
Date of Birth
Gender
Female
Male
Other
Prefer not to say
Contact Number
Email Address
Medical History
Type of Diabetes
Type 1
Type 2
Gestational
Other
None
Date of Diagnosis
Current Medications
Allergies
Chronic Conditions
Eligibility Criteria
Recent HbA1c (%)
BMI
Blood Pressure (mmHg)
Additional Notes