Online enrollment form

Thank you for applying to become a trial participant at Vx Pharma. It is important that we have an accurate record of your medical history, so please complete the form below and submit it to us. We will then attempt to match studies that may be of interest to you and only contact you when necessary. You can count on the security and privacy of your information since all patient source data is stored in dedicated lockable areas at our site that meet the security standards as stipulated by The Protection of Personal Information (POPI) Bill of South Africa. Remember, should we work together now or in future, the safety, health, comfort and happiness of our trial participants are always of great concern to Vx Pharma.