Platinum Lip Plump Phase 2 Clinical trial sign up sheet

Previous clinical trial participant, Platinum Lip Plump

Previous clinical trial participant, Platinum Lip Plump

Previous clinical trial participant, Platinum Lip Plump

Previous clinical trial participant, Platinum Lip Plump

Please fill in the information below in order to participate in our Phase 2 Clinical Trial for Platinum Lip Plump on Wednesday, February 14, 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 Lip Plump, clinical photography, and completing a 6-item questionnaire. You are welcome to come at any time between 9am and 5pm.

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 mini sample tube of Platinum Lip Plump.

Name *
Name
Gender *
Are you a healthy adult with no open sores or lesions in or on your mouth or lips? *
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 Wednesday, February 14, 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.
Have you ever had injectable lip filler? *
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.
Do you agree to share a photo of Platinum Lip Plump applied to your lips on a social media post or story and tag @devganscientificbeauty and #scientificbeauty? *
A "yes" answer is required for participation in this clinical study.
(Optional)