Platinum Long Lash Phase 2 Clinical trial sign up sheet

 Previous clinical trial participant, Platinum Long Lash

Previous clinical trial participant, Platinum Long Lash

 Dr. Devgan Scientific Beauty Platinum Long Lash.

Dr. Devgan Scientific Beauty Platinum Long Lash.

Please fill in the information below in order to participate in our Phase 2 Clinical Trial for Platinum Long Lash on Thursday, March 15th, 2018 from 9am to 5pm at 969 Park Avenue, New York, New York 10028.

Participation in this clinical trial is a 5-10 minute commitment that involves application of Platinum Long Lash, clinical photography, and completing a 6-item questionnaire. You are welcome to come at any time between 9am and 5pm. In addition, we will be trialling several other products from the Dr. Devgan Scientific Beauty line, including Platinum Eye Repair Complex, Platinum SPF 45 Daily Tinted BB Cream, the Neck's Best Thing, and a few other novel products under development.  

If you are selected for participation, you will receive an email confirmation. As a thank you for your cooperation, all clinical trial participants will receive a complimentary full size bottle of Platinum Long Lash (value of $150) .

Name *
Name
Gender *
Are you a healthy adult with no open sores or lesions on your face? *
A "yes" answer is required for participation in this clinical study.
Are you available to be present at 969 Park Avenue, New York, New York 10028 on Thursday, March 15th, 2018 for 15 minutes between 9am and 5pm (at a time convenient for you)? *
A "yes" answer is required for participation in this clinical study.
Do you voluntarily consent to the use of your images and videos for research, educational, and promotional purposes in print, online, or televised material, releasing Dr. Devgan Scientific Beauty and Lara Devgan, MD and their associates of any liability, financial claims, or damages? *
A "yes" answer is required for participation in this clinical study.
Are you able to visit Dr. Devgan's office after 2 and 4 months for follow-up photography? *
A "yes" answer is required for participation in this clinical study.
Do you agree to share a photo of Platinum Long Lash and any other Dr. Devgan Scientific Beauty products you receive during the clinical trial on a social media post or story and tag @devganscientificbeauty and #scientificbeauty? *
A "yes" answer is required for participation in this clinical study.
(Optional)