Submit an intake participation request.

Use the form below to start the intake participation process. Provide your contact information so our team can follow up with account-related updates about your request and next steps.

Intake Participation Form

Full Name *

Email *

Mobile Number (optional)

General account notifications

By checking this box, I consent to receive SMS messages from Vertex Medical Labs related to my intake request and account updates at the mobile number provided. Message frequency varies. Message & data rates may apply. I understand I can reply STOP to opt out at any time or HELP for assistance. Consent is not a condition of participation. My mobile number will only be used for the communication preferences I select and will not be shared with third parties or affiliates.

Marketing

By checking this box, I agree to receive marketing SMS messages from Vertex Medical Labs regarding research participation opportunities and related updates. Message frequency varies. Message & data rates may apply. I understand I can reply HELP for assistance or STOP to opt out at any time. Consent is not required to participate. My mobile number will not be shared with third parties or affiliates.

Terms & Privacy

Terms & Privacy Policy

After submission, we’ll review your request. If additional details are needed, we’ll reach out using the contact information you provided.

Privacy Policy Terms of Use

This form is a participation request. It is not medical advice and does not guarantee eligibility or placement in any study.