Allergy & Asthma Research Associates

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Allergy and Asthma Research Associates is seeking qualified candidates to participate in our allergy and asthma drug studies. If you are interested in becoming a study participant, please complete the form below. One of our Study Coordinators will then contact you to set up an appointment.

To be considered, applicants must reside in Western Washington State (our research center is located in Kirkland, WA).

Name
Address
City
State
ZIP
Home Phone
Work Phone
E-Mail
Date of Birth
Guardian
(if under 18 years of age)
Year of Diagnosis

What is your smoking history?

Never Smoked Current Smoker Former Smoker

If you're a former smoker, when did you quit?

If you're a current or former smoker, how many packs per day do/did you smoke?

For how many years?

What medications do you currently take for your asthma?

Bronchodilators Corticosteroids
Albuterol Inhaler Aerobid/ Aerobid M
Maxair Inhaler Azmacort
Proventil Inhaler Beclovent
Proventil Repetabs Flovent ( µg/puff)
Theophylline Tablets Pulmicort
Tornalate Inhaler Vanceril/ Vanceril DS
Serevent Inhaler/Diskus Prednisone( mg/day)
Ventolin Inhaler Pulmicort
Volmax QVAR
Nebulizers Others
Albuterol Accolate
Atrovent Advair ( µg/puff)
Cromolyn Alupent
Intal Atrovent
Proventil Combivent
Pulmicort Cromolyn
Non-Prescription Intal
Bronchaid Methotrexate
Primatene Mist Singulair
Primatene Tablets
Tilade
Zyflo

What medications do you currently take for your allergies?

Antihistamines/ Decongestants Nasal Sprays
Allegra/ Allegra D Astelin
Benadryl Atrovent
Bromfed/ Bromfed PD Flonase
Claritin Nasacort
Claritin D Nasalcrom
Clarinex Nasonex
ENTEX LA Nasarel
Guaifed/ Guaifed PD Rhinocort
Zyrtec Vancenase/ Vancenase AQ
None - prescription

Do you get allergy injections? Yes No

Please descibe any additional medical conditions, and medications used for treatment if applicable:

 

Our Address:
Evergreen Professional Plaza
Suite F-260, 12911 120th Avenue
Kirkland, WA 98034
(Across the street from Evergreen Medical Center)
Telephone (425) 899-1191

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