About the Clinic

The Northwest Clinical Research Center has been conducting clinical trials for over 15 years.  We have been extensively involved in research leading to the development of antidepressant medications such as Prozac, Zoloft, Paxil, Wellbutrin, Effexor,  Celexa,  Lexapro, Cymbalta, and Abilify.  Over ten thousand patients have been evaluated for clinical trials at NWCRC.

Call us at 877.453.0404 or visit our website at www.nwcrc.net for more information.

 


Questionnaire:


Please let us know which of the following symptoms you may be experiencing.

 Feeling sad, hopeless, or discouraged Trouble concentrating Feeling restless or irritable Feeling tired or having little energy Struggle to perform daily activities Changes in appetite or weight Feelings of guilt or like a failure Feeling pessimistic about the future None of the Above

Do you have a history of any of the following?

 Seizure Disorder Stroke Head Injury Brain Tumor Cancer NONE

Have you been treated for your depression in the past?

Are you currently taking an Antidepressant medication?

What is your Gender?
 Male Female

Are you over 18?
 Yes No

How did you hear about us?
 TV Radio Referral Flyer/Brochure Internet Search Web Advertisement Facebook Previous Patient

Please enter any questions or comments in the space below.

Name (First and Last):

Phone:

Email Address:

Are you a resident of Washington State?

Zip Code:

What is the best time to contact you?

Your information will not be shared with or sold to anyone without your permission or except as required by law. See our Privacy Statement for details.

 I agree to the Privacy Statement