Document:

<PAGE>

                                                                     Exhibit 4.6

                    [Form of Class A Common Stock Warrant]

         THESE SECURITIES HAVE NOT BEEN REGISTERED UNDER THE SECURITIES ACT OF
         1933 OR ANY STATE SECURITIES LAWS. THEY MAY NOT BE SOLD OR OFFERED FOR
         SALE IN THE ABSENCE OF AN EFFECTIVE REGISTRATION STATEMENT AS TO THE
         SECURITIES UNDER SAID ACT AND ANY APPLICABLE STATE SECURITIES LAWS OR
         EXEMPTION THEREFROM.

                           AMERICASDOCTOR.COM, INC.

                         Class A Common Stock Warrant

                                                                          [Date]

             No.

             AMERICASDOCTOR.COM, INC., a Delaware corporation (herein, together
with its successors and assigns, the "Company"), for value received, hereby
certifies that         , or registered assigns, is entitled to purchase from the
Company, at any time or from time to time prior to 5:00 p.m., Eastern time, on
       ,           duly authorized, validly issued, fully paid and nonassessable
shares of Class A Common Stock, par value $.001 per share, as constituted on the
date hereof (the "Class A Common Stock"), of the Company at a purchase price of
$ per share, all subject to the terms, conditions and adjustments set forth
below in this Warrant.

             1.   Exercise of Warrant.
                  -------------------

             1.1 Manner of Exercise. This Warrant may be exercised by the
                 ------------------
holder hereof, in whole or in part, during normal business hours on any Business
Day by surrender of this Warrant to the Company at the office of the Company
maintained pursuant to Section 7.2(a), accompanied by a subscription in
substantially the form annexed hereto duly executed by such holder and (i) by
payment in cash or by certified or official bank check payable to the order of
the Company or by wire transfer in the amount obtained by multiplying (a) the
number of shares of Class A Common Stock (without giving effect to any
adjustment therein) designated in such subscription by (b) the then applicable
Warrant Price (as defined in Section 2.1(c)), (ii) by instructing the Company to
withhold and cancel a number of shares of Class A Common Stock then issuable
upon exercise of this Warrant with respect to which the excess of the Market
Price of the shares of Class A Common Stock over the Warrant Price for such
canceled shares is at least equal to the Warrant Price for the shares being
purchased, or (iii) by any combination of the foregoing, whereupon such holder
shall be entitled to receive the number of duly authorized, validly issued,
fully paid and nonassessable shares of Class A Common Stock (or Other
Securities) determined as provided in Section 2.

<PAGE>

          1.2   When Exercise Effective. Each exercise of this Warrant shall be
                -----------------------
deemed to have been effected immediately prior to the close of business on the
Business Day on which this Warrant shall have been surrendered to the Company as
provided in Section 1.1, and at such time the Person or Persons in whose name or
names any certificate or certificates for shares of Class A Common Stock (or
Other Securities) shall be issuable upon such exercise as provided in Section
1.3 shall be deemed to have become the holder or holders of record thereof.

          1.3   Delivery of Stock Certificates, etc. As soon as practicable
                -----------------------------------
after the exercise of this Warrant, in whole or in part, and in any event within
five (5) Business Days thereafter, the Company at its expense (including the
payment by it of any applicable issuance taxes) will cause to be issued in the
name of and delivered to the holder hereof or, subject to Section 6, as such
holder (upon payment by such holder of any applicable transfer taxes) may
direct,

          (a)   a certificate or certificates for the number of duly authorized,
     validly issued, fully paid and nonassessable shares of Class A Common Stock
     (or Other Securities) to which such holder shall be entitled upon such
     exercise plus, in lieu of any fractional share to which such holder would
     otherwise be entitled, cash in an amount equal to the same fraction of the
     Market Price per share on the Business Day next preceding the date of such
     exercise, and

          (b)   in case such exercise is in part only, a new Warrant or Warrants
     of like tenor, calling in the aggregate on the face or faces thereof for
     issuance of the number of shares of Class A Common Stock equal (without
     giving effect to any adjustment therein) to the number of such shares
     called for on the face of this Warrant minus the number of such shares so
     designated by such holder upon such exercise as provided in Section 1.1.

          2.    Adjustments to Warrant Price for Diluting Issues:
                ------------------------------------------------

          2.1   Special Definitions.  For purposes of this Section 2, the
                -------------------
following definitions shall apply:

          (a)   "Dilution Price" initially shall mean $       per share, which
     shall be adjusted from time to time as provided in this Section 2 and, as
     so adjusted, shall remain in effect until further adjustment thereof is
     required by this Section 2.

          (b)   "Original Issue Date" shall mean the date hereof.

          (c)   "Warrant Price" initially shall mean $        per share, which
     shall be adjusted and readjusted from time to time as provided in this
     Section 2, and, as so adjusted or readjusted, shall remain in effect until
     further adjustment or readjustment thereof is required by this Section 2.

          2.2   Number of Shares; Warrant Price. The number of shares of
                -------------------------------
Class A Common Stock that the holder of this Warrant shall be entitled to
receive upon exercise hereof shall be determined by multiplying the number of
shares of Class A Common Stock that would otherwise (but for the provisions of
this Section 2) be issuable upon such exercise by a fraction of which the
numerator is $     and the denominator is the Dilution Price in effect on the
date of such exercise.

                                      -2-
<PAGE>

          2.3    Adjustment for Dividends, Distributions, Subdivisions,
                 ------------------------------------------------------
Combinations or Consolidation of Common Stock.
---------------------------------------------

          2.3.1  Stock Dividends, Distributions or Subdivisions. In the
                 ----------------------------------------------
event the Company at any time, or from time to time, after the Original Issue
Date shall declare or pay any dividend or make any other distribution on the
Common Stock payable in Common Stock, or effect a subdivision of the outstanding
shares of Common Stock (by reclassification or otherwise than by payment of a
dividend in Common Stock), then and in any such event, the Warrant Price and the
Dilution Price in effect immediately prior to such stock dividend, stock
distribution or subdivision shall, concurrently with the effectiveness of such
stock dividend, stock distribution or subdivision, be proportionately decreased,
(a) in the case of any such dividend or distribution, immediately after the
close of business on the record date for the determination of holders of any
class of securities entitled to receive such dividend or distribution, or (b) in
the case of any such subdivision, at the close of business on the date
immediately prior to the date upon which such corporate action becomes
effective.

          If such record date shall have been fixed and such dividend shall not
have been fully paid on the date fixed therefor, any adjustment previously made
in the Warrant Price and the Dilution Price, which became effective on such
record date, shall be canceled as of the close of business on such record date,
and thereafter the Warrant Price and the Dilution Price shall be adjusted
pursuant to this Section 2.3 as of the time of actual payment of such dividend.

          2.3.2  Combinations or Consolidations. In the event the
                 ------------------------------
outstanding shares of Common Stock shall be combined or consolidated, by
reclassification or otherwise, into a lesser number of shares of Common Stock,
the Warrant Price and the Dilution Price in effect immediately prior to such
combination or consolidation shall, concurrently with the effectiveness of such
combination or consolidation, be proportionately adjusted.

          2.4    Adjustment for Merger or Reorganization, etc. Subject to
                 --------------------------------------------
the provisions of Section 13, in case of any consolidation or merger of the
Company with or into another Company or the conveyance of all, or substantially
all, of the assets of the Company to another corporation, this Warrant shall
thereafter be exercisable to purchase the number of shares of stock or other
securities or property to which a holder of the number of shares of Class A
Common Stock of the Company deliverable upon exercise of this Warrant would have
been entitled upon such consolidation, merger or conveyance; and, in any such
case, appropriate adjustment (as determined by the Board of Directors) shall be
made in the application of the provisions herein set forth with respect to the
rights and interest thereafter of the holder of this Warrant to the end that the
provisions set forth in Section 2 (including provisions with respect to changes
in and other adjustments of the Warrant Price and the Dilution Price) shall
thereafter be applicable, as nearly as reasonably may be, in relation to any
shares of stock or other property thereafter deliverable upon the exercise of
this Warrant.

          3.   No Dilution or Impairment. The Company (a) will not permit
               -------------------------
the par value of any shares of stock receivable upon the exercise of any Warrant
to exceed the amount payable therefor upon such exercise, (b) will take all such
action as may be necessary or appropriate in order that the Company may validly
and legally issue fully paid and nonassessable shares of stock on the exercise
of the Warrants from time to time outstanding, and (c) will not take any action
which results in any adjustment of the Warrant Price if the total number of
shares of Class A Common Stock (or

                                      -3-
<PAGE>

Other Securities) issuable after such action, upon the exercise of all of the
Warrants, would exceed the total number of shares of Class A Common Stock (or
Other Securities) then authorized by the certificate of incorporation and
available for the purpose of issuance upon such exercise.

          4.   Report as to Adjustments. In each case of any adjustment or
               ------------------------
readjustment in the shares of Class A Common Stock (or Other Securities)
issuable upon the exercise or conversion of any Warrant, the Company at its
expense will promptly compute such adjustment or readjustment in accordance with
the terms of the Warrants and prepare a report setting forth such adjustment or
readjustment and showing in detail the method of calculation thereof and the
facts upon which such adjustment or readjustment is based, including a statement
of (a) the number of shares of Common Stock outstanding or deemed to be
outstanding and (b) the Warrant Price and Dilution Price in effect immediately
prior to such issuance or sale and as adjusted and readjusted (if required by
Section 2) on account thereof. The Company will forthwith (and in any event not
later than 20 days following the occurrence of the event requiring such
adjustment) furnish a copy of each such report to each holder of a Warrant, and
will, upon the written request at any time of any holder of a Warrant, furnish
to such holder a like report setting forth the Warrant Price and Dilution Price
at the time in effect and showing how it was calculated. The Company also will
keep copies of all such reports at its principal office and at the office or
agency required to be maintained by it pursuant to Section 7.2(a), and will
cause the same to be available for inspection at each such office during normal
business hours by any holder of a Warrant.

          5.   Restrictions on Transfer.
               ------------------------

          5.1  Restrictive Legends. Except as otherwise permitted by this
               -------------------
Section 5, each Warrant originally issued, each Warrant issued upon direct or
indirect transfer or in substitution for any Warrant pursuant to Section 7, each
certificate for Class A Common Stock (or Other Securities) issued upon the
exercise of any Warrant, and each certificate issued upon the direct or indirect
transfer of any such Class A Common Stock (or Other Securities), shall be
stamped or otherwise imprinted with legends in substantially the following form:

     THESE SECURITIES HAVE BEEN ACQUIRED PURSUANT TO A TRANSACTION
     EFFECTED IN RELIANCE UPON AN EXEMPTION FROM THE SECURITIES ACT OF
     1933, AS AMENDED (THE "ACT"), AND HAVE NOT BEEN THE SUBJECT OF A
     REGISTRATION STATEMENT UNDER THE ACT OR ANY STATE OR OTHER
     SECURITIES LAWS. THEY MAY NOT BE SOLD OR OTHERWISE TRANSFERRED IN
     THE ABSENCE OF REGISTRATION OR AN EXEMPTION THEREFROM, AND, IF
     APPLICABLE, IN ACCORDANCE WITH THE PROVISIONS OF REGULATION S
     UNDER THE ACT, AND THE COMPANY MAY REQUIRE AN OPINION OF LEGAL
     COUNSEL SATISFACTORY TO THE COMPANY THAT ANY PROPOSED TRANSFER OF
     THESE SECURITIES COMPLIES WITH SUCH SECURITIES LAWS BEFORE SUCH A
     TRANSFER MAY BE EFFECTED.

     THE SECURITIES REPRESENTED HEREBY ARE SUBJECT TO THE TERMS AND
     CONDITIONS OF AN AGREEMENT THAT RESTRICTS THE TRANSFER OF SUCH
     SECURITIES (AND THE SECURITIES ISSUABLE UPON EXERCISE HEREOF) FOR
     180 DAYS FOLLOWING THE EFFECTIVE DATE OF A REGISTRATION STATEMENT
     FILED UNDER THE ACT OR ANY

                                      -4-
<PAGE>

     SUCCESSOR THERETO OR ANY SIMILAR RULE OR LAW OR ANY OTHER
     UNDERWRITTEN SALE OF SECURITIES BY THE COMPANY, AND RESTRICTS THE
     TRANSFER OF SUCH SECURITIES TO TRANSFEREES WHO AGREE TO BE BOUND
     BY THE TERMS AND CONDITIONS OF SUCH AGREEMENT. THIS AGREEMENT IS
     SET FORTH IN THE SUBSCRIPTION AGREEMENT FOR THESE SECURITIES, A
     COPY OF WHICH IS AVAILABLE UPON REQUEST OF THE COMPANY. ANY SALE
     OR TRANSFER NOT IN COMPLIANCE HEREWITH WILL BE VOID.

          5.2  Notice of Proposed Transfer; Opinions of Counsel. Prior to any
               ------------------------------------------------
transfer of any Restricted Securities which are not registered under an
effective registration statement under the Securities Act, the holder thereof
will give written notice to the Company of such holder's intention to effect
such transfer and to comply in all other respects with this Section 5.2. Each
such notice shall (a) describe the manner and circumstances of the proposed
transfer in sufficient detail to enable counsel to render the opinion referred
to below, and (b) designate counsel for the holder giving such notice, which
counsel shall be reasonably satisfactory to the Company. The holder giving such
notice will submit a copy thereof to the counsel designated in such notice. The
following provisions shall then apply:

               (1) if in the written opinion of such counsel for the holder,
          obtained at the holder's sole cost and expense and a copy of which
          shall be delivered to the Company and shall be reasonably satisfactory
          in form, scope and substance to the Company, the proposed transfer may
          be effected without registration of such Restricted Securities under
          the Securities Act or applicable state securities laws, such holder
          shall thereupon be entitled to transfer such Restricted Securities in
          accordance with the terms of the notice delivered by such holder to
          the Company. Each Restricted Security or certificate, if any, issued
          upon or in connection with such transfer shall bear the appropriate
          restrictive legends set forth in Section 5.1 unless, in the opinion of
          such counsel, the first such legend is no longer required to insure
          compliance with the Securities Act and applicable state securities
          laws; and

               (2) if the opinion of such counsel rendered pursuant to the
          foregoing subdivision (1) is not to the effect that the proposed
          transfer may legally be effected without registration of such
          Restricted Securities under the Securities Act or applicable state
          securities laws (such opinion to state the basis of the legal
          conclusions reached therein), such holder shall not be entitled to
          transfer such Restricted Securities (other than a transfer pursuant to
          Rule 144, Rule 144A or any comparable rule under the Securities Act)
          until receipt by the Company of a further notice and a further opinion
          of counsel for such holder to the effect stated in subdivision (1)
          above or until registration of such Restricted Securities under the
          Securities Act and applicable state securities laws has become
          effective.

          5.3  Termination of Restrictions. The restrictions imposed by this
               ---------------------------
Section 5 upon the transferability of Restricted Securities shall cease and
terminate, with respect to the restrictions related to the Securities Act, as to
any particular Restricted Securities when, in the opinion of counsel for the
Company, such restrictions are no longer required in order to ensure compliance
with the Securities Act. Whenever such restrictions shall terminate as to any
Restricted Securities, the

                                      -5-
<PAGE>

holder thereof shall be entitled to receive from the Company, without expense
(other than transfer taxes, if any), new securities of like tenor not bearing
the applicable legend set forth in Section 5.1.

          6.   Reservation of Stock, etc. The Company will at all times reserve
               --------------------------
and keep available, solely for issuance and delivery upon the exercise of the
Warrants, the number of shares of Class A Common Stock (or other securities)
from time to time issuable upon the exercise of all Warrants at the time
outstanding. All such securities shall be duly authorized and, when issued upon
such exercise, shall be validly issued and, in the case of shares, fully paid
and nonassessable with no liability on the part of the holders thereof.

          7.   Ownership Transfer and Substitution of Warrants.
               -----------------------------------------------

          7.1  Ownership of Warrants. The Company may treat the Person in whose
               ---------------------
name any Warrant is registered on the register kept at the principal office of
the Company as the owner and holder thereof for all purposes, notwithstanding
any notice to the contrary, except that, if and when any Warrant is properly
assigned in blank, the Company may (but shall not be obligated to) treat the
bearer thereof as the owner of such Warrant for all purposes, notwithstanding
any notice to the contrary. Subject to Section 5, a Warrant, if properly
assigned, may be exercised by a new holder without first having a new Warrant
issued.

          7.2  Office; Transfer and Exchange of Warrants. (a) The Company will
               -----------------------------------------
maintain its principal office in Gurnee, Illinois or at such other location as
it designates in a written notice delivered to each registered holder of a
Warrant prior to any change of such location, and all notices, presentations and
demands in respect of this Warrant may be made upon it at such location. The
Company may designate from time to time by notice to the registered holder of
this Warrant an office or agency of the Company where such notices,
presentations and demands in respect of this Warrant may be made in lieu of the
Company's principal office.

          (b)  Upon the surrender of any Warrant, properly endorsed, for
registration of transfer or for exchange at the principal office of the Company
or the office of the Company maintained pursuant to Section 7.2(a), the Company
at its expense will (subject to compliance with Section 5, if applicable)
execute and deliver to or upon the order of the holder thereof a new Warrant or
Warrants of like tenor, in the name of such holder or as such holder (upon
payment by such holder of any applicable transfer taxes) may direct, calling in
the aggregate on the face or faces thereof for the number of shares of Common
Stock called for on the face or faces of the Warrant or Warrants so surrendered.

          7.3  Replacement of Warrants. Upon receipt of evidence reasonably
               -----------------------
satisfactory to the Company of the loss, theft, destruction or mutilation of any
Warrant (which may be a written statement as to such loss, theft, destruction or
mutilation) and (a) in the case of such loss, theft or destruction of any
Warrant, upon delivery of indemnity reasonably satisfactory to the Company in
form and amount, or (b) in the case of any such mutilation, upon surrender of
such Warrant for cancellation at the office of the Company maintained pursuant
to Section 7.2(a) or the principal office of the Company, the Company at its
expense will execute and deliver, in lieu thereof, a new Warrant of like tenor.

          8.   Definitions.  As used herein, unless the context otherwise
               -----------
requires, the following terms have the following respective meanings:

                                      -6-
<PAGE>

          "Business Day" shall mean any day other than a Saturday, Sunday or any
           ------------
other day on which U.S. Federal Reserve member banks are not open for business
in Chicago, Illinois.

          "Commission" shall mean the Securities and Exchange Commission or any
           ----------
other Federal agency at the time administering the Securities Act.

          "Common Stock" shall mean, collectively, the Class A Common Stock and
           ------------
the Class B Common Stock, $.001 par value per share, of the Company and any
stock into which such Common Stock shall have been changed or any stock
resulting from any reclassification of such Common Stock.

          "Company" shall have the meaning specified in the opening paragraphs
           -------
of this Warrant, including any corporation that shall succeed to or assume the
obligations of the Company hereunder in compliance with Section 2.5.

          "Dilution Price" shall have the meaning specified in Section 2.1 (a).
           --------------

          "Exchange Act" shall mean the Securities Exchange Act of 1934, or any
           ------------
similar Federal statute, and the rules and regulations of the Commission
thereunder, all as the same shall be in effect at the time.

          "Market Price" shall mean, per share of Class A Common Stock that the
           ------------
holders of the Warrants shall be entitled to receive upon exercise thereof, on
any date specified herein, (a) the last sale price on such date of such Class A
Common Stock or, if no such sale takes place on such date, the average of the
closing bid and asked prices thereof on such date, in each case as officially
reported on the principal national securities exchange on which such Class A
Common Stock is then listed or admitted to trading, or (b) if such Class A
Common Stock is not then listed or admitted to trading on any national
securities exchange but is designated as a national market system security by
the National Association of Securities Dealers, Inc., the last trading price of
such Class A Common Stock on such date, or (c) if there shall have been no
trading on such date or if such Class A Common Stock is not so designated, the
average of the reported closing bid and asked prices of such Class A Common
Stock on such date as shown by NASDAQ and reported by any member firm of the New
York Stock Exchange selected by the Company, or (d) if neither (a), (b) nor (c)
is applicable, a price per share thereof equal to the fair value thereof
determined in good faith by a resolution of the Board of Directors of the
Company as of a date which is within 15 days of the date as of which the
determination is to be made.

          "Original Issue Date" shall have the meaning set forth in Section
           -------------------
2.1(b).

          "Other Securities" shall mean any stock (other than Class A Common
           ----------------
Stock) and other securities of the Company or any other Person (corporate or
otherwise) that the holders of the Warrants at any time shall be entitled to
receive, or shall have received, upon the exercise of the Warrants, in lieu of
or in addition to Class A Common Stock, or that at any time shall be issuable or
shall have been issued in exchange for or in replacement of Class A Common Stock
or Other Securities pursuant to Section 2 or otherwise.

          "Person" shall mean a corporation, an association, a partnership, an
           ------
organization or business, an individual, a government or political subdivision
thereof or a governmental agency.

                                      -7-
<PAGE>

          "Restricted Securities" shall mean (a) any Warrants bearing the
           ---------------------
applicable legend set forth in Section 5.1, (b) any shares of Class A Common
Stock (or Other Securities) issued upon the exercise of Warrants which are
evidenced by a certificate or certificates bearing the applicable legend set
forth in such Section and (c) any shares of Class A Common Stock (or Other
Securities) issued subsequent to the exercise of any of the Warrants as a
dividend or other distribution with respect to, or resulting from a subdivision
of the outstanding shares of Class A Common Stock (or Other Securities) into a
greater number of shares by reclassification, stock splits or otherwise, or in
exchange for or in replacement of the Class A Common Stock (or Other Securities)
issued upon such exercise, which are evidenced by a certificate or certificates
bearing the applicable legend set forth in such section.

          "Securities Act" shall mean the Securities Act of 1933, or any
           --------------
similar federal statute, and the rules and regulations of the Commission
thereunder, all as the same shall be in effect at the time.

          "Warrants" shall have the meaning specified in the opening paragraphs
           --------
of this Warrant.

          "Warrant Price" shall have the meaning specified in Section 2.1(c).
           -------------

          9.   Remedies. The Company stipulates that the remedies at law of the
               --------
holder of this Warrant in the event of any default or threatened default by the
Company in the performance of or compliance with any of the terms of this
Warrant are not and will not be adequate, and that, to the extent permitted by
applicable law, such terms may be specifically enforced by a decree for the
specific performance of any agreement contained herein or by an injunction
against a violation of any of the terms hereof or otherwise.

          10.   No Rights or Liabilities as Stockholder. Nothing contained in
                ---------------------------------------
this Warrant shall be construed as conferring upon the holder hereof any rights
as a shareholder of the Company or as imposing any obligation on such holder to
purchase any securities or as imposing any liabilities on such holder as a
shareholder of the Company, whether such obligation or liabilities are asserted
by the Company or by creditors of the Company.

          11.   Notices. All notices and other communications provided for
                -------
herein shall be delivered or mailed by first class mail, postage prepaid,
addressed (a) if to any holder of any Warrant, at the registered address of such
holder as set forth in the register kept by the Company, or (b) if to the
Company, at its principal office, 1325 Tri-State Parkway, Gurnee, Illinois
60031, or at the address of such other principal office of the Company as the
Company shall have furnished to each holder of any Warrants in writing, with a
copy to Jones, Day, Reavis & Pogue, 77 West Wacker Drive, Chicago, Illinois
60601; provided, however, that the exercise of any Warrant shall be effective in
       --------  -------
the manner provided in Section 1.

          12.   Miscellaneous. This Warrant and any term hereof may be changed,
                --------------
waived, discharged or terminated only by an instrument in writing signed by the
party against which enforcement of such change, waiver, discharge or termination
is sought. Any waiver, amendment or other modification hereof shall be binding
on any subsequent holder without any further action by the Company. Any
provision of this Warrant that shall be prohibited or unenforceable in any
jurisdiction shall, as to such jurisdiction, be ineffective to the extent of
such prohibition or

                                      -8-
<PAGE>

unenforceability without invalidating the remaining provisions hereof, and any
such prohibition or unenforceability in any jurisdiction shall not invalidate or
render unenforceable such provision in any other jurisdiction. To the extent
permitted by applicable law, the Company waives any provision of law that shall
render any provision hereof prohibited or unenforceable in any respect. This
Warrant shall be governed by the substantive laws of the State of Delaware
without reference to the choice of law rules thereof. The headings of this
Warrant are inserted for convenience only and shall not be deemed to constitute
a part hereof.

     13.  Expiration. Subject to the provisions in Section 1.1 hereof, the
          ----------
right to exercise this Warrant shall expire at 5:00 p.m., Eastern time, on     .

                                    AMERICASDOCTOR.COM INC.

                                    By: _________________________________
                                           Name:
                                           Title:

                                      -9-
<PAGE>

                             FORM OF SUBSCRIPTION
                             --------------------

                [To be executed only upon exercise of Warrant]

To AMERICASDOCTOR.COM, INC.

          The undersigned registered holder of the attached Warrant hereby
irrevocably exercises such Warrant for, and purchases thereunder,      /1/
shares of Class A Common Stock of AMERICASDOCTOR.COM, INC., and herewith makes
payment as follows (check as applicable): [_] certified or official bank check
in the amount of $_________; [_] wire transfer in the amount of $_________; or
[_] cancellation of _______ shares of Class A Common Stock otherwise issuable
under the Warrant. The undersigned requests that the certificates for such
shares be issued in the name of, and delivered to          , whose address is:

Dated:

                                  ______________________________________________
                                  (Signature must conform in all respects
                                  to name of holder as specified on the face
                                  of Warrant)

                                  ______________________________________________
                                  (Street Address)

                                  ______________________________________________
                                  (City)       (State)       (Zip Code)

________________

1.    Insert here the number of shares called for on the face of this Warrant
      (or in the case of a partial exercise, the portion thereof as to which
      this Warrant is being exercised), in either case without making any
      adjustment for additional Class A Common Stock or any other stock or other
      securities or property or cash which, pursuant to the adjustment
      provisions of this Warrant, may be delivered upon exercise. In the case of
      a partial exercise, a new Warrant or Warrants will be issued and
      delivered, representing the unexercised portion of the Warrant, to the
      holder surrendering the Warrant.<PAGE>

                                                                     Exhibit 4.7

                     CLINICAL RESEARCH SERVICES AGREEMENT
                     ------------------------------------

THIS CLINICAL RESEARCH SERVICES AGREEMENT ("Agreement") is entered into and
effective as of the date set forth on the signature page hereto by and between
AMERICASDOCTOR.COM, INC., a Delaware corporation AD and the entity conducting
research trials pursuant to the terms and conditions of this Agreement as set
forth on the signature page hereto ("Affiliate").

                                  DEFINITIONS
                                  -----------

Affiliate:               The legal entity executing this Agreement with AD,
                         including the Medical Director and all medical,
                         clerical and research personnel employed or under
                         contract or associated with Affiliate.

Affiliate Site:          The individual location(s), including the premises and
                         facilities, approved by AD for the performance of
                         clinical research trials by Affiliate under this
                         Agreement.

Confidential             Information, including, but not limited to, trade
Information:             secrets concerning the business and affairs of AD or
                         Affiliate, know-how, processes, inventions and ideas,
                         past, current and planned research and development,
                         clinical tests, records, agreements, correspondence,
                         techniques, procedures, research subject lists, market
                         studies, business plans, computer software and database
                         technologies, and information concerning the business
                         and affairs of AD or Affiliate (which includes
                         financial information, the names and background of key
                         personnel, personnel training techniques and
                         materials), and any other confidential or proprietary
                         information of AD or Affiliate that is provided to the
                         other party to this Agreement during the term of this
                         Agreement and any renewals hereof. Confidential
                         Information does not include information that AD or
                         Affiliate, as applicable, demonstrates (a) was, is or
                         becomes generally available to the public other than as
                         a result of a disclosure by AD or Affiliate, as
                         applicable, or their respective representatives, (b)
                         was, is or becomes available to AD or Affiliate, as
                         applicable, on a non-confidential basis from a source
                         other than the other party to this Agreement or its
                         representatives, which AD or Affiliate, as applicable,
                         believes, after reasonable inquiry, is not prohibited
                         from disclosing such portions to it by a contractual,
                         legal or fiduciary obligation, or (c) was available to
                         AD or Affiliate, as applicable, on a non-confidential
                         basis prior to its disclosure to AD or Affiliate, as
                         applicable, by the other party to this agreement.

<PAGE>

FDA:                     United States Food and Drug Administration.

FDA Form 1572:           FDA Form required to be completed by the Principal
                         Investigator for each clinical research study, whereby
                         Principal Investigator agrees to conduct clinical
                         research according to a filed protocol and following
                         GCPs.

GCPs:                    Good Clinical Practices; the body of FDA regulations
                         and guidelines governing the conduct of clinical
                         research, as set forth in Title 21, Code of
                         Federal Regulations and any successor thereto or
                         replacement thereof.

IRB:                     Institutional Review Board; the legal entity charged
                         under GCPs with protecting the rights and safety of
                         clinical study participants.

Medical Director:        The person designated by Affiliate as the contact
                         person with whom AD is authorized and directed to
                         communicate with respect to conduct of clinical
                         research trials under this Agreement.

Primary Study            The person designated by Affiliate as the contact
Coordinator:             person with whom AD is authorized and directed to
                         communicate with respect to administrative conduct of
                         clinical research trials under this Agreement.

Principal                The investigator, which may be the Medical Director,
Investigator:            who executes the Form 1572 for a particular clinical
                         research study protocol and is principally
                         responsible for such study.

Interdisciplinary        A representative group of Medical Directors selected
Physician Advisory       by the affiliates  to assist AD in setting standards
Board                    for admission  as an affiliate, maintaining affiliate
                         quality, furthering strategic growth of the affiliates
                         and advising AD on protocols and study budgets for the
                         affiliates.

Sponsor:                 Pharmaceutical company, device manufacturer,
                         biotechnology company, contract research organization
                         or other entity that sponsors clinical research trials.

Sub-Investigators:       Additional investigators designated on Form 1572 as
                         "Sub-Investigators," including Medical Director and
                         such other professionals as may be designated by
                         Medical Director or Principal Investigator.

<PAGE>

                                   RECITALS
                                   --------

I.         AD will be entering into contracts with Sponsors to provide services
designed to facilitate the completion of Phase II, III and IV human clinical
trials in order to assist Sponsors in meeting their FDA regulatory requirements.

     A.    AD has developed effective and efficient in-house operating
procedures and policies for, and is experienced in, facilitating clinical
research trials on behalf of Sponsors.

     B.    Affiliate is experienced in the performance of clinical research
trials.

     C.    Affiliate desires to become a member of  AD's  affiliate organization
and to make available its resources and facilities for the performance of such
clinical research trials as may be offered through  AD pursuant to the terms and
conditions of this Agreement and any other agreements relating to such trials.

     NOW, THEREFORE, in consideration of the mutual promises and covenants
contained herein, the parties agree as follows:

                                   ARTICLE I
                               OBLIGATIONS OF AD
                               -----------------

     1.01  Duties and Obligations.   AD assumes the following duties and
           ----------------------
obligations in accordance with the terms and conditions of this Agreement:

     (a)   Submission to Institutional Review Board. AD will submit to an IRB,
           ----------------------------------------
for the IRB's review and approval, all preliminary information regarding a
proposed study, including, but not limited to, a study protocol, a report on
prior investigations into the particular product, research subject consent forms
and research subject solicitation materials, as well as the curriculum vitae of
the Principal Investigator, Affiliate Site demographics, and Form 1572.

     (b)   Education and Training.  In accordance with guidelines established by
           ----------------------
AD and the Physician Interdisciplinary Advisory Board,  AD will assist Affiliate
in developing its capacity to perform  AD-contracted clinical research trials
efficiently.  Such education and training will include, among other things,
introduction to  AD's standards of performance and training in GCPs and will
include training for all principal investigators and study coordinators at AD's
corporate headquarters. Unless AD advises Affiliate otherwise, training and
education will  be provided on a tuition-free basis. Affiliate will be
responsible for all travel, lodging and meal costs for Affiliate personnel.

     (c)   Marketing.   AD has implemented a centralized national marketing
           ---------
program intended to increase the visibility of the research affiliates.  Such
marketing services include direct sales calls, direct mailings, exposure at
industry trade shows and assistance in the preparation of suitable marketing and
advertising materials relating to research subject recruitment.
<PAGE>

     (d)   Research Subject Enrollment.  Where appropriate,  AD will provide
           ---------------------------
assistance in research subject enrollment for clinical research trials,
including identification, documentation to be signed by research subjects,
advertising, and consultation with Affiliate personnel.

     (e)   Quality Assurance.   AD will, at its discretion and in accordance
           -----------------
with its quality assurance policies and procedures, as in effect from time to
time, provide an annual site qualification review by a consultant or AD employee
to assure continuing site quality. AD will provide assistance upon request to
Affiliate on issues of quality assurance. Depending on the circumstances, the
level of assistance requested and the out-of-pocket costs associated with the
assistance, Affiliate may be required to reimburse AD for services provided.

     (f)   Collection and Disbursement of Funds.   AD will collect the fees
           ------------------------------------
payable from Sponsors under clinical research trial contracts performed by
Affiliate and will disburse such funds received to Affiliate, less the  AD
administrative fee set forth in Section 4.03 hereof.

     (g)   Budget and Contract Negotiation.  AD will be responsible for all
           --------------------------------
negotiations relating to clinical research trial budgets and contracts with
Sponsors.

     (h)   Database Security.   AD will be provide Affiliate with access to and
           -----------------
support an off site hosting facility that will contain an electronic patient
database consisting of information related to clinical trials. The hosting
facility will be in material compliance with the requirements of Health
Insurance Portability and Accountability Act, as it may be amended from time to
time  ("HIPAA") and applicable federal and state regulations relating to patient
data security.

     (i)   SIP Database. AD will provide Affiliate with use of its proprietary
           ------------
Site Information Profile (SIP) database as it may be altered or upgraded from
time to time.

     (j)   Site Branding. AD will provide Affiliate the materials and guidelines
           -------------
setting forth the method by which Affiliate shall brand the Affiliate Site as an
"AmericasDoctor Research Site."  These materials may include, but not be limited
to, standardized business cards, letterhead, signage, name tags, lapel pins,
voicemail and phone greeting scripts, clinical trial opportunity brochures,
disease awareness flyers, and templates for recruitment advertisements.

     (k)   Site Web Page Development & Services. AD will develop and provide
           -------------------------------------
Affiliate with standardized AmericasDoctor Web page template.

                                  ARTICLE II
                                  ----------
                           OBLIGATIONS OF AFFILIATE
                           ------------------------

     2.01  Duties and Obligations.  Affiliate assumes the following duties and
           ----------------------
obligations in accordance with the terms of this Agreement:

     (a)   Procedures and Protocols.  Affiliate will conduct clinical research
           ------------------------
trials in accordance with  AD standard operating procedures and policies
including, but not limited to:   (1) confidentiality of clinical research trial
information, (2) ethical handling of clinical research trial opportunities, (3)
development of mutually agreeable budgets, (4) development of expectations for
research subject enrollment for individual clinical research trials, (5)
adherence
<PAGE>

to AD's quality control efforts on behalf of Sponsors, (6) conformity in
completing case report forms provided by AD and/or Sponsors and (7) daily
reporting to AD with respect to the status of any clinical research trials or
other matters associated with AD being conducted by Affiliate, including,
without limitation, information with respect to research subject enrollment.
Affiliate will require each of its new Principal Investigators and Study
Coordinators to attend AD's training courses on GCPs and AD policies and
procedure, which training courses shall be provided by AD's corporate
headquarters. Each new Study Coordinator is required to successfully complete
such training courses within 60 days following commencement of their employment
with Affiliate or the date of its execution of this Agreement, whichever is
later, and each new Principal Investigator is required to successfully complete
such training courses within 90 days following commencement of their employment
with Affiliate or the date of execution of this Agreement, whichever is later.

     (b)   Designation and Approval of Medical Director.  Affiliate will
           --------------------------------------------
designate a qualified person to serve as the Medical Director for each Affiliate
Site, subject to AD's review and approval. Affiliate must advise AD of any
proposed change of the Affiliate's Medical Director for an Affiliate Site and
obtain AD's approval of the new person designated. AD may request additional
information regarding the qualifications and background of the Medical Director
as a condition of approval, which approval may be conditioned upon the approval
of the AD and the Physician Interdisciplinary Advisory Board.

     (c)   Duties of Medical Director.   AD will direct clinical research trial
           --------------------------
contract opportunities to the attention of the Medical Director who will have
the authority to bind Affiliate and each of its investigators that has executed
Appendix 1 hereto to the terms of a particular Sponsor study contract.  The
Medical Director will have full authority to act on behalf of Affiliate in all
matters relating to the Affiliate's interests in  AD.  The Medical Director must
ensure that the election to participate in any clinical research trial
opportunity offered by  AD to Affiliate is timely made and that all of the terms
and conditions of acceptance are fully performed on a timely basis.  The Medical
Director is also responsible for ensuring that  AD has all the information
necessary to prepare a Form 1572, and ensuring that each Form 1572 is reviewed,
approved and signed by the Principal Investigator.

     (d)   Designation and Role of Principal Investigator.  Affiliate will
           ----------------------------------------------
designate a qualified licensed physician to serve as the Principal Investigator
for each clinical research trial contract offered to Affiliate, subject to AD's
review and approval.  AD recognizes that different persons may need to be
designated to serve as the Principal Investigator for a particular study to meet
Sponsor expectations.  Affiliate must advise  AD of any proposed change of the
Affiliate's Principal Investigator for a particular study and obtain AD's
approval of the new person designated.  AD may request additional information
regarding the qualifications and background of the Principal Investigator as a
condition of approval, which approval may be conditioned upon the approval of AD
and the  Physician Interdisciplinary Advisory Board.  Each Principal
Investigator must execute Appendix as amended from time to time.

     (e)   Designation of Sub-Investigators.   The Medical Director or Principal
           --------------------------------
Investigator may designate qualified licensed physicians to serve as Sub-
Investigators for each clinical research trial contract offered to Affiliate,
subject to AD's review and approval.  The Medical Director and/or Principal
Investigator must ensure that any Sub-Investigator(s)
<PAGE>

designated for participation in a particular study are listed on the FDA Form
1572 for that study, if so required.

     (f)   Designation and Role of Primary Study Coordinator.  One person at
           -------------------------------------------------
each Affiliate Site must be designated to serve as the Primary Study Coordinator
and notice of this designation must be timely given to AD.

     (g)   On-Site Visitations.  Affiliate will permit a consultant or  AD
           -------------------
employee to evaluate the Affiliate's compliance with GCPs and procedures and
policies of  AD, the applicable Interdisciplinary Physician Advisory Board
and/or Sponsors through on-site visitations.  Regularly scheduled visits will
take place at least annually at mutually convenient times scheduled in advance
with Affiliate.  Affiliate will receive a visit report after each visit
iterating issues needing correction, and suggestions for improving performance
of study protocols.

     (h)   Expansion of Services.  Affiliate will demonstrate a willingness to
           ---------------------
expand its research capabilities to fully participate in its therapeutic
specialty and to conform with procedures adopted by  AD to ensure the quality
and efficient performance of clinical research trials.

     (i)   Resources and Facilities.  Acceptance by Affiliate of an  AD-offered
           ------------------------
clinical research trial contract indicates that Affiliate has available and
agrees to provide the personnel, supplies, facilities and other resources
required to properly perform that clinic research trial at the Affiliate Site.
Affiliate acknowledges that the services it provides hereunder may only be
performed by Affiliate at the Affiliate Site(s) designated herein or as  AD may
subsequently approve in writing.

     (j)   Management Information Systems. Affiliate will use the management
           ------------------------------
information system provided by AD for reporting accurate information on clinical
research trials and will institute such reasonable procedures as may be required
to be implemented at the Affiliate Site(s).  Affiliate agrees to obtain and
maintain appropriate hardware and software sufficient to perform functions
reasonably required by AD hereunder.

     (k)   External Contracts.  Affiliate will abide by the terms and conditions
           ------------------
of any contracts with Sponsors, or other service contracts, which affect, either
directly or indirectly, the fulfillment of AD's duties thereunder.  Affiliate
agrees that, in negotiating such contracts,  AD may identify Affiliate, Medical
Director, Principal Investigator and the Affiliate Site as an entity, person or
research site that has agreed to perform clinical research trials on behalf of
AD, subject to the terms of this Agreement.

     (l)   Professional Licensure.  Affiliate will maintain for each of its
           ----------------------
professional employees and contractors an unrestricted license to practice their
profession in the state(s) in which they practice.

     (m)   Applicable Standards; Compliance with Laws.  Affiliate will, at all
           ------------------------------------------
times during the term of this Agreement, comply with all applicable standards
set forth by law or ordinance or established by the rules and regulations of any
Federal, state or local agency, department, commission, association or other
governing or advisory body having authority to set standards governing the
practice of medicine, the conduct of clinical research trials and the
<PAGE>

operation or use of any services or facilities which may be subject to such
regulation, including, but not limited to the FDA regulations applicable to the
performance of clinical research trials, maintenance and use of laboratory or
diagnostic imaging services and facilities and the maintenance of such drug
licenses and certifications as may be necessary in the performance of clinical
research trial studies.

     (n)   Database Security. Affiliate will fully comply with the requirements
           -----------------
of HIPAA and all-applicable federal, state or local laws with respect to
securing of patient data. Affiliate may elect to satisfy its obligation under
this paragraph by utilizing AD's hosting facility, at no cost to Affiliate. If
Affiliate elects to satisfy its obligation under this paragraph independently,
any costs incurred shall be borne by Affiliate and Affiliate must provide AD, on
a quarterly basis, with written verification of compliance.

     (o)   SIP Database. Affiliate must complete and maintain Site Information
           ------------
Profile (SIP) database for the Affiliate Site and all key personnel. Key site
personnel shall include all of Affiliate's Principal Investigators and Study
Coordinators. If Affiliate fails to adequately and accurately complete and
maintain the SIP Database with respect to the Affiliate Site and the key
personnel, AD will, in its sole discretion, assume responsibility for completion
and maintenance of the SIP database for an initial fee of $2,250 (to be paid
within 10 days following AD's notification to Affiliate that it is assuming such
responsibilities) and an annual maintenance fee of $1,000 (to be paid within 20
business days following the end of each calendar year AD will complete and
maintain SIP database for an initial fee of $2,250 and an annual maintenance fee
of $1,000.

     (p)   Site Branding. Affiliate agrees to brand the Affiliate Site in
           -------------
accordance with AD's branding guidelines and by incorporating all of the
following standardized elements provided by AD: business cards, letterhead,
signage, name tags, lapel pins, voice mail and phone greeting templates,
clinical trial opportunity brochures, disease awareness flyers, and recruitment
advertisement template. The development of materials for the Affiliate Site and
the initial branding package delivered by AD will be at no cost to Affiliate.
Affiliate agrees that all Medical Director business cards used for research
purposes will clearly identify the Medical Director as an AmericasDoctor
research physician.

     (q)   Site Web Page. Affiliate agrees to use AD's standardized Web page
           -------------
format for its Web site. If Affiliate does not have a Web site, it agrees to
promptly create a Web site. At Affiliate's election, Affiliate may utilize the
basic standardized template, which will be made available to Affiliate by AD at
no charge.

                                  ARTICLE III
                           COVENANTS AND CONDITIONS
                           ------------------------

     3.01  Confidential Information.   AD and Affiliate each acknowledges that
           ------------------------
it will have access to, and special knowledge of, certain Confidential
Information of the other party.  Affiliate grants to  AD the right and authority
to accept Confidential Information from Sponsors on behalf of Affiliate, and
acknowledges that  AD may disclose Confidential Information received from
Affiliate to Sponsors for the purpose of assisting Sponsors in site selection.
With regard to the Confidential Information of the other party,  AD and
Affiliate each agrees that:
<PAGE>

     (a)   the Confidential Information will, at all times, be and remain the
exclusive property of  AD or Affiliate, as applicable;

     (b)   during the term of this Agreement and any renewals hereof, neither
party will directly or indirectly use for any purpose, copy, disclose to any
third-party or convey to any third-party any Confidential Information of the
other party, except as may be required by or permitted to  AD under this
Agreement or as may be required by applicable law; and

     (c)   at any time following termination of this Agreement by either party
for any reason, neither party will directly or indirectly use for any purpose,
copy, retain or disclose or convey to any third-party any Confidential
Information without the prior written approval of the other party.

     3.02  Non-Solicitation of Personnel.  During the term of this Agreement and
           -----------------------------
for a period of one (1) year following termination of this Agreement, regardless
of the manner in which such termination occurs, neither AD nor Affiliate will
recruit or hire individuals employed by the other party or another Affiliate
during the term of this Agreement without the written consent of the other
party. If Affiliate fails to comply with this Section 3.02, AD will either bill
Affiliate for an amount equal to $5,000 per violation or will withhold an amount
equal to $5,000 per violation from amounts owed by AD to Affiliate. If AD fails
to comply with this Section 3.02, Affiliate will bill AD for an amount equal to
$5,000 per violation.

     3.03  Exclusivity.  Except as otherwise approved in advance in writing by
           -----------
AD, Affiliate's conduct of clinical research trials will be provided exclusively
through this Agreement, and Affiliate will refrain from entering into a contract
for clinical research trials with any Sponsor independently of  AD.  This
restriction covers the performance of all clinical research trials, whether
performed directly for a Sponsor or indirectly under subcontract with respect to
any portion of such clinical trial services.

     Not withstanding the above, Affiliate may and is encouraged to continue to
solicit and entertain (but not negotiate) clinical research trial contracts with
Sponsors and may participate in the development of the protocols associated with
such clinical research trials, but clinical research trial contracts so obtained
must be placed in the name of or assigned to AD and made subject to the terms of
this Agreement at AD's election, except as may be prohibited by the law
associated with a particular grant or government program. Under no circumstances
is Affiliate authorized to bind AD to any clinical research trial contract
without AD's prior written authorization, counter-signature or subsequent
written ratification. Similarly, Affiliate is not authorized to negotiate or
accept a budget directly with a Sponsor, or to recommend specific Affiliate
Sites to a Sponsor, unless AD has decided not to participate in a study and has
turned the study over to the Affiliate for independent pursuit.

     Clinical research trial contract opportunities offered to Affiliate
directly by a Sponsor must be disclosed on a timely basis to AD for review and
determination as to whether such clinical research trial contract opportunity is
(i) consistent with AD's standards of scientific integrity, (ii) on terms
consistent with those generally negotiated by or acceptable to AD, and (iii)
within the range of studies in which AD is presently interested and over which
AD is capable of exercising its management and supervision, and, as a result,
whether AD desires to be
<PAGE>

assigned such contract or whether under the circumstances such contract is most
appropriately performed by Affiliate in Affiliate's own name. AD and the
Physician Interdisciplinary Advisory will appoint Medical Directors to assist AD
in evaluating studies and protocols.

     If AD determines that such a study is outside its interest, Affiliate may
seek from AD a waiver of the exclusivity requirements for such study. If a
waiver is sought, Affiliate must submit a written request for a waiver to the
Director of Medical Affairs. If approved, Affiliate may independently perform
such study. If a waiver is granted by AD, AD will not provide any of the
services to be provided by AD hereunder with respect to such study. These
services include, but are not limited to, contract review, budget negotiation
and regulatory document preparation.

     Affiliate acknowledges that all contracts presented to Affiliate by AD
under this Agreement belong to AD and are between AD and any given Sponsor.
Should Affiliate decide not to pursue a clinical research trial contract
opportunity initially offered by AD, Affiliate remains bound by this Agreement
not to subsequently pursue such contract directly with such Sponsor or disclose
to any other party that Sponsor-specific and clinical trial-specific
information.

     3.04  Covenant Not to Compete.  Affiliate and each of its partners,
           -----------------------
employees, members, officers, directors, affiliates and principal stockholders
(collectively, for purposes of this Section, the "Affiliate") acknowledges that
during the course of its association with AD, AD will expend substantial time,
effort and money to, among other things, market the name and clinical research
practice of Affiliate using contacts established by AD. Affiliate recognizes and
agrees that in express consideration of AD's agreement to promote the services
of Affiliate, Affiliate hereby covenants that it will not join, form or contract
with another enterprise providing services similar in purpose to any part of the
business of AD, for a period of one (1) year following termination of this
Agreement for any reason. Furthermore, if any other entity acquires control of
Affiliate or any substantial part of Affiliate's assets, this covenant not to
compete will bind such third party and restrict such third party from joining,
forming or participating in another such enterprise, provided that nothing
herein will prevent Affiliate from performing clinical research trials
independently with its own employees.

     3.05  Right of First Performance.  Affiliate will have the first right and
           --------------------------
priority to perform any clinical research trials introduced by Affiliate to AD,
provided Affiliate is qualified to do so, has the present capacity to perform
the requirements thereof on a timely and efficient basis, and is selected by the
Sponsor.

     3.06  Right of Refusal.  Affiliate has the right to refuse any clinical
           ----------------
research trial presented to it by AD, and AD does not have the right to commit
Affiliate to the performance of any particular clinical research trial contract
without Affiliate's prior oral commitment. AD has the right to rely upon an oral
commitment by Affiliate to participate in a particular clinical research trial
and Affiliate will confirm such commitment in writing to the extent required by
AD. By offering a clinical research trial contract to Affiliate, AD does not
guarantee that the Affiliate will be selected as a site for that study by the
Sponsor.

     3.07  Compliance with Performance Standards.  Affiliate's compliance with
           -------------------------------------
the standards for the performance of clinical research trials established from
time to time by  AD is a material condition to this Agreement.
<PAGE>

     3.08  Publication. Any publication of research results by the Affiliate or
           -----------
Affiliate's employees and agents will be subject to prior written approval by
AD, which approval, subject to any restrictions imposed by  AD's Sponsors, will
not be unreasonably withheld or delayed. Affiliate also acknowledges that it
may not solicit research subjects pursuant to any public advertisement or other
public communication regarding a particular clinical research trial or for
screening for participation in future clinical research trials that are or may
be performed hereunder without  AD's prior written approval of the method and
content of the proposed communication.

     3.09  Additional Certifications. Affiliate agrees to execute and deliver
           -------------------------
such additional certifications and/or documentation as may be required by  AD
regarding the confidentiality of the arrangement described in this Agreement,
and will obtain such certifications and/or documentation from its affiliates,
employees and agents, including specifically, an acknowledgment of their
individual duties and responsibilities under this Agreement from Affiliate's
Medical Director, Principal Investigator(s) and Primary Study Coordinator.

                                  ARTICLE IV
                                 COMPENSATION
                                 ------------

     4.01  Investigative Site Services. AD agrees to pay Affiliate for all
           ---------------------------
pre-negotiated- per-research subject costs associated with the institutional,
professional and administrative services provided by Affiliate for every
clinical research trial contract accepted by Affiliate, pursuant to the terms
and conditions set forth in such contract. Each contract will include a budget
and a schedule of all-rental fees, personnel rates, administrative costs, prices
and payment terms. All costs and fees set forth in the schedule will be fixed
and not subject to change during any clinical research trial without the written
approval of  AD. In general, Affiliate will be entitled to receive eighty
percent (80%) of the net revenues received by  AD from the Sponsor in connection
with the investigative site services provided by Affiliate and AD will be
entitled to receive twenty percent (20%) of these net revenues.

     4.02  AD Central Services. In addition to investigative site services
           -------------------
provided by Affiliates, Sponsors contract with AD for services that are not
related to patient care and case report form data and which are provided by AD
central employees. Such services include, but are not limited to patient
recruitment services, project management services, protocol development and
administrative services. AD is entitled to retain one hundred percent (100%) of
any fees for AD Central Services. If Affiliate personnel provide certain AD
Central Services at the express request of AD, Affiliate will receive
compensation as agreed with AD in advance of delivery of such AD Central
Services.

     4.03  Performance Bonuses. AD may from time to time attempt to negotiate
           -------------------
contracts with Sponsors that specifically provide for the payment of a bonus
directly to Affiliate for exceeding a specified quota or meeting any other bonus
criterion. If Affiliate earns an enrollment bonus which results directly from
AD services, including, but not limited to, patient recruitment services and
project management service. AD shall deliver the bonus to Affiliate and an
administrative fee shall be charged. If AD negotiates a contract with a sponsors
that
<PAGE>

specifically provide for payment of a performance bonus directly to Affiliate
for exceeding a specified quota or meeting any other bonus criterion and AD is
not and had not provided any services in connection therewith, including, but
not limited to, patient recruitment and project management. The bonus will be
delivered by AD to Affiliate without charge for an administrative fee. If AD
negotiates a bonus with regard to AD's services, Affiliate will not receive any
portion of such bonus.

     4.04  Right to Invest in AD Shares. Unless otherwise restricted by law or
           ----------------------------
otherwise, and subject to the terms and conditions of any applicable offering,
Affiliate will be required to purchase a minimum number of shares of AD directly
from AD under such common stock offering as may then be in effect and may be
entitled to purchase additional shares of stock in such offering or a subsequent
offering. Nothing in this Section 4.04 shall require AD to make available to
Affiliate a common stock offering.

     4.05  Payment Procedures. All fees for clinical research trial services
           ------------------
provided by Affiliate hereunder would be paid to Affiliate by  AD and under no
circumstances will such fee-for-service payments or supplemental payments are
made directly to Affiliate. To the extent that it becomes necessary for the
Sponsor to make the fees payable to Affiliate, Affiliate hereby appoints and
authorizes  AD to act as Affiliate's billing and collection agent for such
payments, and to deposit such payments in  AD's account subject to the terms
hereof. If any Sponsor contract requires the refund of any advance payments for
services that Affiliate has failed or been unable to perform for any reason,  AD
will have the right, if such fees are not refunded by Affiliate, to offset such
amount against any other fees due from  AD to Affiliate and to take such other
action as may be appropriate to recover the amount of any such refund and the
cost related to collecting such amount.

     4.06  Billing. AD specifically prohibits Affiliate from billing, and
           -------
Affiliate hereby agrees not to bill, a third party payor or a study research
subject for any services covered by a clinical research trial budget and
contract, unless expressly authorized to do so under the terms of the clinical
research trial contract.  AD and Affiliate will take all necessary measures to
assure that no "double-billing" occurs either by intent or oversight.

                                   ARTICLE V
                         INSURANCE AND INDEMNIFICATION
                         -----------------------------

     5.01  Insurance.
           ---------

     (a) Affiliate will provide, at its sole cost and expense, throughout the
term of this Agreement, (i) a policy of commercial general liability insurance
in a minimum aggregate amount of Three Million Dollars ($3,000,000) covering
Affiliate and each Affiliate Site (such amount subject to increase in order to
reflect then current industry practices), and (ii) professional liability
insurance covering each professional authorized to provide professional services
in connection with a clinical research trial pursuant to this Agreement with a
licensed insurance company admitted to do business in the Affiliate state in an
amount usual and customary for a medical practice in Affiliate's particular
medical specialty in Affiliate's state, as reported to and approved by  AD or
the  Interdisciplinary Physician Advisory Board, but in no event shall such
professional liability coverage be less than One Million Dollars ($1,000,000)
per
<PAGE>

occurrence. Upon termination of this Agreement, Affiliate must ensure that
"tail" coverage is provided for the services provided under this Agreement for a
minimum of five (5) years.

     (b)   Affiliate must provide, or cause its insurance carrier(s) to provide,
to AD a minimum of thirty (30) days' prior written notice of any cancellation,
modification or amendment of any policy of insurance required under this
Article. Affiliate must, from time to time on the reasonable request of AD,
furnish to AD written evidence that the policies of insurance required by this
Agreement are in full force and effect, and are valid and existing in accordance
with the provisions of this Agreement.

     5.02  Indemnification.
           ---------------

     (a)   Sponsor:  AD will pursue contracts with Sponsors who provide
           --------
           indemnification for adverse outcome(s) that may occur in an enrolled
           research subject as a result of the performance of the Sponsor's
           protocol, provided that the conditions specified by the Sponsor are
           complied with; such conditions generally require that (1) such
           research subject has given prior written informed consent to
           participate in the IRB-approved protocol, (2) the Affiliate has
           treated such research subject in full compliance with such protocol,
           and (3) Affiliate has complied with the terms of the particular
           Sponsor protocol in reporting any adverse events to the Sponsor, and
           thereafter treated the research subject in accordance with the
           standards of care indicated. Any such indemnification will be subject
           to the specific indemnification conditions for a particular clinical
           research trial, which conditions will be available upon written
           request to AD. This indemnification will generally be available to
           Affiliate, all research subjects enrolled in an AD-provided clinical
           trial being conducted by Affiliate, the Principal Investigator, any
           Sub-Investigators and all personnel employed by Affiliate involved
           with the performance of such IRB-approved clinical research trial.

                                  ARTICLE VI
                             TERM AND TERMINATION
                             --------------------

     6.01  Term  Unless sooner terminated as provided herein, the initial
           ----
term of this Agreement will be for a period of three (3) years, commencing on
the date first set forth above (the "Initial Term") Unless sooner terminated as
provided herein, the Initial Term will be automatically extended for two
additional terms of three (3) years each unless one party gives written notice
to the other party of its intent not to renew at least one hundred twenty (120)
days prior to the end of the initial term or any renewal term hereof.

     6.02  Termination Without Cause.  Either party may terminate this agreement
           -------------------------
for any reason following one hundred and twenty (120) days' prior written notice
to the other party

     6.03  Termination for Cause. This Agreement may be terminated for "cause"
           ---------------------
upon the occurrence of any of the following:

     (a)   Immediately upon Affiliate's loss of any license required to operate
the Affiliate Site for the conduct of clinical research trials;
<PAGE>

     (b)   Immediately upon failure by Affiliate to comply with the GCPs or to
maintain AD's standards of quality and scientific integrity, including
specifically, any falsification or intentional mislabeling of data or research
subject screening information;

     (c)   Immediately upon failure by Affiliate to maintain a duly approved
Medical Director, Principal Investigator and/or Primary Study Coordinator for
the conduct of clinical research trials performed hereunder; and

     (d)   Immediately upon Affiliate's debarment from clinical research
participation by local, state, or Federal authorities.

     6.04  Effect of Termination. Any study in progress at the time of
           ---------------------
termination of this Agreement, may, at the sole discretion and option of AD, be
continued to its completion upon the terms and conditions otherwise set forth
herein, or discontinued immediately upon termination of this Agreement. To the
extent AD obtains a related payment from the applicable Sponsor, Affiliate will
be paid for work performed up to the time of termination following proper
completion of Sponsor-directed procedures, tests and case report forms, as
specified in the clinical research trial protocol. If this Agreement is
terminated for any reason, all of the covenants and conditions of Article III of
this Agreement will survive such termination.

                                  ARTICLE VII
                                    RECORDS
                                    -------

     7.01  Retention of Records.  Affiliate agrees to maintain all records
           --------------------
associated with any given clinical research trial in a separate, reasonable and
retrievable location for a period of not less than two (2) years following the
completion of the clinical research trial, or for such longer period as required
by the contract therefor or by FDA regulations. All such records will remain the
property of Affiliate, but will be available to AD to the extent specified in
Section 7.02.

     7.02  Medical Records. Affiliate agrees to allow  AD and its duly
           ---------------
authorized representatives to inspect, audit and duplicate any and all data and
other records referred to in Section 7.01, including records maintained on
research subjects pursuant to this Agreement. Such inspection, audit and
duplication will be allowed upon reasonable notice during regular business
hours. Subject to all applicable privacy and confidentiality requirements,
medical records of Affiliate will be made available to AD and the Research
Network Governing Board and their duly authorized representatives upon
reasonable request in order to allow for quality assurance review and
credentialling, as may be applicable.

                                 ARTICLE VIII
                            INDEPENDENT CONTRACTOR
                            ----------------------

     8.01  Independent Contractor.  In the performance of the duties and
           ----------------------
obligations required of each party under this Agreement, it is mutually
understood and agreed that the parties are not forming nor will they function
hereunder as employer-employee or joint ventures or partners of each other, and
that AD and Affiliate are at all times hereunder acting and performing as
independent contractors as to each other.
<PAGE>

                                   ARTICLE IX
                            MISCELLANEOUS PROVISIONS
                            ------------------------

     9.01  Complete Agreement. This Agreement constitutes the entire agreement
           ------------------
between the parties with respect to the subject matter hereof, and may be
amended only in writing signed by the parties. This Agreement supersedes any
prior clinical research services agreement between the parties.

     9.02  Scope of the Agreement. This Agreement covers all clinical research
           ----------------------
trial contracts negotiated after Affiliate/L/F acceptance of this Agreement, and
any contracts AD and Affiliate negotiated in good faith in anticipation of
formalization of this Agreement.

     9.03  Governing Law. This Agreement will be construed in accordance with
           -------------
the internal laws of the State of Illinois without regard to the principles of
conflicts thereof.

     9.04  Headings. The headings in this Agreement are for reference purposes
           --------
only and are not intended to have any substantive effect upon the Agreement.

     9.05  Notice. Any notice required to be given by one party to the other
           ------
party must be personally delivered or sent via certified mail, return receipt
requested (or sent by a nationally recognized overnight courier such as Federal
Express or UPS), or dispatched by electronic facsimile transmission (with
receipt thereof confirmed) to the following address, unless otherwise directed
in writing:

     Affiliate:     Name, address and facsimile number of Affiliate as provided
                    on the signature page hereof.

     AD:            AMERICASDOCTOR.COM, INC.
                    1325 Tri-State Parkway, Suite 300
                    Gurnee, Illinois  60031
                    Attention:  President, Research Services
                    Facsimile:  (847) 855-8787

     9.06  Dispute Resolution.
           ------------------

     (a)   Any dispute arising out of or relating to this Agreement will be
settled by arbitration. The following rules apply to arbitration: (i) the then
current CPR Non-Administered Arbitration Rules (adopted by the CPR Institute for
Dispute Resolution) will govern, and the United States Federal Arbitration Act,
9 U.S.C.(S) 1-16, will also govern to the extent consistent; (ii) there will be
one independent arbitrator selected in accordance with the CPR Non-Administered
Arbitration Rules; (iii) the place of arbitration will be Chicago, Illinois;
(iv) the arbitrator shall not be empowered to award damages in excess of
compensatory damages, and each party hereby irrevocably waives any right to
recover such damages; (v) as a primary goal of this Section 9.06 is to conclude
disputes in a speedy manner at substantially less cost to the parties than
litigation, the arbitrator is therefore to conduct the proceedings in a speedy
and expeditious manner, each party is limited to presenting two days of evidence
including up to
<PAGE>

three live witnesses, and the arbitrator shall issue an award within seven days
after the last hearing date; and (vi) the arbitrator's decision will be final
and binding and judgment upon the award rendered by the arbitrator may be
entered by any court having jurisdiction.

     (b)   Each party must bear its own costs of resolving any dispute under
this Agreement and AD and Affiliate each hereby severally agree to pay 50% of
the costs of any arbitrator engaged.

     (c)   Each party is required to continue to perform its obligations under
this Agreement pending final resolution of any dispute arising out of or related
to this Agreement, unless it would be impossible to do so or impracticable under
the circumstances.

     9.07  Attorneys' Fees. In the event of legal action arising from, or
           ---------------
related to, the terms of this Agreement, the prevailing party may recover all of
his, her or its actual attorneys' fees and costs incurred in connection with the
action, unless the applicable tribunal hearing the matter specifically finds
that the fees were grossly unreasonable in amount.

     9.08  Severability. If any provision of this Agreement is rendered invalid
           ------------
or unenforceable for any reason, the remainder of the provisions of this
Agreement will remain in full force and effect. However, if the removal of any
particular provision materially alters the obligations of either party hereto,
the party so affected has the right to terminate this Agreement immediately.

     9.09  Waiver of Breach. Waiver of a breach of any provision of this
           ----------------
Agreement is not a waiver of any other breach of either the same or any
different provision.

     9.10  Assignment. The rights, duties and obligations of Affiliate under
           ----------
this Agreement may not be assigned by Affiliate without the prior written
consent of AD, which consent may be withheld, in AD's sole discretion, subject
to the proposed assignee meeting all of AD's credentialling requirements and the
proposed assignee's ability to competently and efficiently perform clinical
research trials on behalf of AD. Notwithstanding the foregoing, Affiliate may
assign all of its rights and obligations hereunder to a conduit entity, such as
a limited liability company, limited liability partnership or sub-chapter S
corporation, into which Affiliate has reorganized; provided, however, that such
                                                   --------  -------
reorganization does not substantially change the nature of Affiliate's business
or the underlying ownership thereof. AD may assign all or any part of its rights
hereunder to any affiliate of AD or to any acquirer of AD or all or any
substantial portion of the assets of AD.

     9.11  Counterparts. This Agreement may be executed by counterparts.
           ------------

     9.12  Survival. Any provision of this Agreement that by its terms is to
           --------
survive the termination of this Agreement will continue in full force and effect
in accordance with its terms following termination of this Agreement for any
reason.

                 [Remainder of Page Intentionally Left Blank]

<PAGE>

          IN WITNESS WHEREOF, the parties have executed this Agreement as of the
last date written below.

AMERICASDOCTOR.COM, INC. a                  AFFILIATE:
Delaware corporation

                                            ____________________________________
By: ____________________________            Name of Entity Conducting Trials
             Signature
                                            By: ________________________________
________________________________                            Signature
Print Name
                                            ____________________________________
Its: ___________________________            Print Name
              Title
                                            Its: _______________________________
Date: __________________________                              Title

                                            Date: ______________________________

                                            Affiliate Site:

                                            ____________________________________
                                            Address

                                            ____________________________________
                                            City, State, Zip

                                            ____________________________________
                                            Telephone Number

                                            ____________________________________
                                            Facsimile Number

                                            ____________________________________
                                            Medical Director:

                                            ____________________________________
                                            Name of Affiliate's Designee (Print)

                                            ____________________________________
                                            Signature

                                            Primary Study Coordinator:

                                            ____________________________________
                                            Name of Affiliate's Designee (Print)

<PAGE>

                                  APPENDIX I

                    INVESTIGATOR AUTHORIZATION OF AFFILIATE
                    ---------------------------------------

     The undersigned Principal Investigators hereby authorize _____________
___________________________________________________________________________
_______________ to represent them, and their legal entity indicated beneath
their names below (if any), in contractual obligations to and through AD. Every
Principal Investigator proposed by Affiliate is subject to approval by AD for
participation in any Research Network, and every Principal Investigator that is
not an owner or employee of Affiliate will be required to execute a Principal
Investigator Agreement in such form as may then be approved by AD. This
authorization gives Affiliate the authority to file an application on behalf of
the Principal Investigators for the approval of the Principal Investigator's
participation in a Therapeutic Specialty and of the Principal Investigator
Agreement with the AD Affiliate, where applicable. Furthermore, this
authorization gives Affiliate the authority to bind the undersigned to the
Affiliate's Agreement with AD and through AD to contracts with Sponsors, as well
as to divulge information relevant to the undersigned's research experience,
practice demographics, and scientific and medical expertise.

(1)  _____________________________________________
     Print Name

     ______________________________________       ______________________
     Signature                                    Date

     ___________________________________________________________________
     Name of Legal Entity, if any

(2)  _____________________________________________
     Print Name

     ______________________________________       ______________________
     Signature                                    Date

     ___________________________________________________________________
     Name of Legal Entity, if any

(3)  _____________________________________________
     Print Name

     ______________________________________       ______________________
     Signature                                    Date

     ___________________________________________________________________
     Name of Legal Entity, if any

(4)  _____________________________________________
     Print Name

     ______________________________________       ______________________
     Signature                                    Date

     ___________________________________________________________________
     Name of Legal Entity, if any

<PAGE>

(5)  _____________________________________________
     Print Name

     ______________________________________       ______________________
     Signature                                    Date

     ___________________________________________________________________
     Name of Legal Entity, if any

(6)  _____________________________________________
     Print Name

     ______________________________________       ______________________
     Signature                                    Date

     ___________________________________________________________________
     Name of Legal Entity, if any

(7)  _____________________________________________
     Print Name

     ______________________________________       ______________________
     Signature                                    Date

     ___________________________________________________________________
     Name of Legal Entity, if any

(8)  _____________________________________________
     Print Name

     ______________________________________       ______________________
     Signature                                    Date

     ___________________________________________________________________
     Name of Legal Entity, if any

(9)  _____________________________________________
     Print Name

     ______________________________________       ______________________
     Signature                                    Date

     ___________________________________________________________________
     Name of Legal Entity, if any

(10) _____________________________________________
     Print Name

     ______________________________________       ______________________
     Signature                                    Date

     ___________________________________________________________________
     Name of Legal Entity, if any

Source: [{"source": "alea-institute/alea-institute/kl3m-data-edgar-agreements/train-00024-of-00352.parquet"}, [{"source": "alea-institute/alea-institute/kl3m-data-edgar-agreements/train-00024-of-00352.parquet"}]]