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Interested in participating in research studies at Zen Dermatology? Join our registry!
Joining our registry is voluntary. You may refuse to join, or you may withdraw your consent to be in the registry for any reason, without penalty. Have questions? Please contact
Mincy Chakkalakal OR Kayla Bensen at firstname.lastname@example.org or call (279) 204-7338
1. What's the purpose of this registry? The purpose of this research registry is to create a database in order to contact participants about current or future research.
2. How many people will take part in this study? If you agree to participate in the registry, the questionnaire on the next page will ask you for information about you like medical history and contact information. This information will then be used to contact you about current or future research studies.
3. How will your privacy be protected? There is always a risk of breach of confidentiality, but we will take measures to protect your privacy. All of the data you provide will be securely stored and only accessible by authorized study staff.
4. What if you want to stop before your part in the study is complete? You can withdraw from this registry at any time.
5. Will you receive anything for being in this registry? Will it cost anything? There are no costs to participate in this registry. You will not receive any monetary reward for participating in this registry.
6. What if you have questions about this registry? You have the right to ask, and have answered, any questions you may have about this registry. Contact the personnel listed above at any time with any questions you may have.
7. Consent I understand that by signing up to participate in this registry I am only signing up to be contacted about potential research studies and I understand that I would still have to qualify to participate in a given research study by meeting study criteria and that I am not guaranteed to be able to participate in future studies.
I consent to participate or I'm a parent/guardian consenting for a minor