Panelist Sign Up Form

  • Participate in Our Studies!

    Complete the form below to be considered for our studies. All information provided is protected and private. We do not share your information with anyone outside of ALS.
  • Today's Date*
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  • Date of Birth*
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  • Tell us about yourself!

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  • How would you describe your hair (check all that apply)?*
  • How would you describe your eyelashes (check all that apply)?*
  • What is the state of your eyebrows (check all that apply)?*
  • What is the state of your facial hair (check all that apply)?*
  • If yes, where?*
  • If yes, where?*
  • Do you have facial piercings?*
  • Rows
  • If you have sensations when using personal care products, how long do they last?*
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  • Tell us about your health!

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  • Any known allergies?*

  • Do you take any of the following dietary / health supplements?*

  • FEMALES ONLY

  • MALES ONLY

  • What is your current shaving system? *

  • Tell us about your lifestyle!

  • Please rate your stress level*
  • If yes, how often?*

  • Tell us about your skincare!

  • Have you received any of these services in the last 30 days?*
  • What Skin Care Products do you currently use (check all that apply)?*
  • Have you ever received chemical peels, laser services, or microdermabrasion treatments? *
  • If yes, where do you shave, wax or use depilatories?*
  • If yes, where?*
  • What type of facial cleanser do you use?*
  • What type of toner do you use?*
  • What type of mask do you use?*
  • What type of moisturizer do you use?*
  • What type of foundation do you use?*
  • What type of nail/hand care do you use?*
  • When shopping for skincare, what solutions do you typically look for?*
  • What type of specialty products do you use?*
  • If yes, do you experience the feeling of any of the following when using?*

  • Media Lab Science!

  • What medium(s) are you interested in?*
  • Rows

  • Thank you for completing the form!

    We will contact you if we need further information or if you are eligible for a study.

  • This collected information will be used by ALS to determine my eligibility in clinical studies. This information is kept confidential and will not be disclosed to anyone outside of ALS. For California residents, you can read more to understand the privacy considerations taken according to the California Consumer Privacy Act (CCPA).

  • Please take a moment to read and understand the ALS Privacy Policy.

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