pilot study form

LunaVax MAP Pilot Study Portal

Help reimagine vaccine delivery in Nigeria. Fill out the form below to express interest in partnering on our microneedle vaccine patch (MAP) pilot. Your participation could help shape a more accessible, community-driven future for immunization.

Whether you’re a clinic, pharmacy, outreach provider, or immunization lead, we’d love to hear from you.

Please enable JavaScript in your browser to complete this form.

piloting your interested

Name *

First

Last

Email *

Phone

Facility or Organization Name *

Where is your site based? (City/State) *

Role *e.g., Clinic Admin, Pharmacist, Program ManagerClinic AdminPharmacistNurseOutreach LeadProgram ManagerProgram CoordinatorOther (please specify)

Does your site currently offer measles vaccinations? *

• Yes
• No

What types of vaccines do you currently deliver? *

• Measles
• Polio
• Hepatitis B
• Other

Do you have experience with immunization programs? *

• Yes
• No
• Other

Are you interested in piloting microneedle vaccine patches at your site? *

• Yes
• No

Are you open to joining a training or feedback session? *

• Yes
• No

Briefly tell us why you’re interested in joining this pilot *

Upload any relevant license or facility document (optional)

Click or drag a file to this area to upload.

Submit

Read the full post about the clinic & pharmacy pilot here.