Access Research Registry: Join the Participant List

Thank you for your interest in the Access Research Registry.

Please complete the following survey to create a profile. Online enrollment will take approximately 10 minutes.

Questions marked with a star (*) are required fields.

Please use the "Previous Page" and "Next Page" buttons at the bottom of the page to navigate the form. You may use the Tab key to navigate the form.

Information is collected and stored on a secure website protected by web application firewall (WAF). For more details on how we work to ensure your privacy, visit ahs.ca or email mhresearch@ucalgary.ca

Page 1 of 5

At this time, online enrollment in the Access Research Registry is limited to individuals 18 years of age and older.

If you are not 18 years of age or older, please contact the Clinical Research Coordinator at mhresearch@ucalgary.ca to discuss potential involvement in the Access Research Registry. Parental/guardian permission will be required.

*Date of Birth:

* must provide value

D-M-Y

At this time, enrollment in the Access Research Registry is limited to individuals residing in Calgary and surrounding areas.

*Location Verification:

* must provide value

You are invited to join the Access Research Registry

The Access Research Registry was created to assist researchers in the Department of Psychiatry identify individuals who may be interested in participating in their research efforts. By sharing your experiences with researchers, we gain new insights into issues that may be important to you and to others who share similar experiences.

If you choose to join, information about you will be collected and stored in the Access Research Registry. Only research staff from the Alberta Health Services (AHS) Department of Psychiatry with approved projects are allowed access to the registry. All projects are approved by the University of Calgary Research Ethics Board prior to anyone contacting you.

Both registry enrollment and participation in research studies are voluntary. Your ongoing or future care from AHS will not be affected if you do not join the registry, or choose to withdraw your information at a later date. You can contact the Access Research Registry coordinator at any time if you wish to withdraw your information from the registry.

How does the Access Research Registry work?

If you are identified as a potentially eligible candidate for a study, you may be contacted about participation by research staff. If you are contacted, you will be provided a thorough explanation of the study and asked if you are interested in being screened to determine if the study if a good fit for you.

How to reach us

Contact the Access Research Registry coordinator at (587) 779-5557 or mhresearch@ucalgary.ca

AHS is committed to protecting the privacy of Albertans. If you have questions about privacy, you may contact the AHS Information and Privacy Office by calling 1-877-476-9874 or privacy@ahs.ca

Consent Statement:

* must provide value

*I understand that any personal information I may choose to provide directly to the Access Research Registry is being collected in compliance with the Health Information Act and the Freedom of Information and Protection of Privacy Act.

* must provide value

*I understand that by enroling in the Access Research Registry, the information about me may be accessed and used by approved AHS researchers to identify me as a potential research participant.

* must provide value

*I understand that I may withdraw my consent to participate in the Access Research Registry at any time.

Sign Date / Time:

D-M-Y H:M:S

You have selected an option that triggers this survey to end right now.

To save your responses and end the survey, click the 'End Survey' button below. If you have selected the wrong option by accident and/or wish to return to the survey, click the 'Return and Edit Response' button.

Access Research Registry: Join the Participant List

Eligibility & Consent Statement

*Date of Birth:

*Location Verification:

You are invited to join the Access Research Registry

How does the Access Research Registry work?

How to reach us

Consent Statement:

Sign Date / Time:

You have selected an option that triggers this survey to end right now.