Clinical Trial Participant Screening Questionnaire
Screens potential participants for eligibility in a specific clinical trial based on inclusion/exclusion criteria.
What Can You Do with Clinical Trial Participant Screening Questionnaire?
Take your form experience to the next level with these powerful features included with this template.
Drag & Drop Builder
Build stunning forms with our intuitive no-code editor.
Full Customization
Match every form to your brand with custom colors, logos, and themes.
Conditional Logic
Smart routing creates personalized journeys for each respondent.
AI Video Insights
AI automatically analyzes responses to surface patterns and trends.
Multi-language
Reach global audiences with automatic translation to 50+ languages.
Integrations
Connect with Zapier, Make, Webhook, n8n and your favorite tools.
What's Inside
Explore all the questions and features included in this template.
Are you between 18 and 65 years old (inclusive) at the time of this screening?
Do you understand and agree to the data privacy policy and informed consent for potential trial participation?
Have you ever been diagnosed with or are currently experiencing severe heart failure (NYHA Class III or IV)?
Which of the following chronic medical conditions, if any, do you currently have?
Please list all prescription medications, over-the-counter drugs, and supplements you are currently taking. Include dosages if known.
Do you have a known severe allergy to any common medications (e.g., penicillin, sulfa drugs) or components potentially found in an investigational product?
For female participants: Are you currently pregnant, breastfeeding, or planning to become pregnant within the next 6 months?
On a scale of 1-5, how would you rate your overall current health and well-being?
Collect → Analyze → Act
Turn this template into a powerful feedback engine in 3 simple steps.
Customize & Share
Brand it with your colors and logo. Share via link, embed, or QR code.
Collect Responses
Receive video, voice, and text responses with automatic transcription.
AI Analyzes & Routes
AI summarizes insights. Webhook & Zapier routes data to your CRM.
Integrations
About the Clinical Trial Participant Screening Questionnaire Template
This template gives you a head start with pre-built questions designed for your use case. Customize the copy, add your logo, and publish — ready in under 2 minutes.
- Conditional logic — questions adapt based on previous answers.
- 8 pre-built questions, ready to customize in minutes.
- AI transcription, sentiment analysis, and theme clustering — automatic.
- Integrates with Zapier, Make.com, Webhooks, and 500+ tools.
Every RecRam template supports video and voice responses, conditional logic, AI analysis, and integration with 500+ tools via Zapier, Make.com, and Webhook. Free forever, no credit card required.
Frequently Asked Questions
Common questions and answers about the Clinical Trial Participant Screening Questionnaire template.
How do I use the Clinical Trial Participant Screening Questionnaire template?
Can respondents fill this form on mobile?
How does the AI analysis feature work?
What tools can I export responses to?
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