The code block below illustrates how one might use # and // as comments in your logic and calculations.

This value you provided is not a number. Please try again.

This value you provided is not an integer. Please try again.

The value entered is not a valid Vanderbilt Medical Record Number (i.e. 4- to 9-digit number, excluding leading zeros). Please try again.

The value you provided must be within the suggested range

The value you provided is outside the suggested range

This value is admissible, but you may wish to double check it.

The value entered must be a time value in the following format HH:MM within the range 00:00-23:59 (e.g., 04:32 or 23:19).

This field must be a 5 or 9 digit U.S. ZIP Code (like 94043). Please re-enter it now.

This field must be a 10 digit U.S. phone number (like 415 555 1212). Please re-enter it now.

This field must be a valid email address (like joe@user.com). Please re-enter it now.

The value you provided could not be validated because it does not follow the expected format. Please try again.

Required format:

N8UUy3dF3oymYq3ErRjoBKpcfZAQPRzXcErgqxiCVp3h73RRTm2Rv8kr6y7VdjgGkcS

C-OPN Self-Registration Form // Formulaire d'auto-inscription du RPCO

Please fill in the fields below in order for the research coordinator to get in contact with you. If you have any questions, contact the National Manager at national.manager@copn-rpco.ca

Thank you!

Veuillez remplir les champs ci-dessous afin que le coordinateur de recherche prenne contact avec vous. Si vous avez des questions, contactez le gestionnaire national à national.manager@copn-rpco.ca

Nous vous remercions !

First Name // Prénom :

Middle Name // Deuxième prénom :

Last Name // Nom :

Phone Number // Numéro de téléphone :

Email Address // Adresse de courriel :

Preferred method of contact // Méthode de contact préférée :

Phone // Téléphone

Email // Courriel

Either // Soit

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Preferred language // Langue de préférence:

English // Anglais

French // Français

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Site at which you would like to enroll // Site auquel vous souhaitez vous inscrire :

* must provide value

Are you registering as a healthy control? // Vous inscrivez-vous en tant que volontaire en bonne santé ?

* must provide value

Yes // Oui

No // Non

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* must provide value

By clicking this box, you agree to have your contact information sent to the Canadian Open Parkinson Network national coordinator AND the site coordinator of your choice. // En cliquant sur cette case, vous acceptez que vos coordonnées soient envoyées au coordinateur national du Réseau Parkinson canadien ouvert ET au coordinateur du site de votre choix.

For Coordinator Use

Has this record been assigned to a DAG? (To be completed by National Manager only)

Yes

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Has this person been contacted by the coordinator?

Yes

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Participant Status:

Participant Status Comment

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You have selected a participant status (enrolled, deceased, declined, or excluded) that results in contact information being deleted from the Self-Registration REDCap instrument in accordance to the C-OPN Self-Registration Protocol by the National Manager at the end of the month. Do you confirm that this information should be deleted this time?

**Note if the participant is enrolled, all of the individual's contact information should be copied in the C-OPN REDCap project.**

* must provide value

Yes

reset

C-OPN Project ID:

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.

C-OPN Self-Registration Form // Formulaire d'auto-inscription du RPCO

My Information // Mon information

For Coordinator Use

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