MIAMI RESEARCH ASSOCIATES - HOME PAGE CLICK HERE 

WEIGHT LOSS STUDY

Please fill out this online registration form and a Study Coordinator will contact you.  
Otherwise, you can simply call us directly at (305) 665-5151 for more information about this 
Weight Loss Research Study
.

Red= Required information.  This form will not send if this field is empty.

First Name & M.I

Last Name

Date of Birth 

Age

Sex

  Weight Height

E-mail

Address

City

State

Zip

Day Phone

Eve Phone

Where did you hear 
about us?

 Cell/Beeper: 

Specify:

 

Please include any message or comments :

 

 

 

 

For immediate  information, please call our office at 305.665.5151.

2002-03 © Copyright Miami Research Associates. All Rights Reserved