Participate in a study at the Alberta Diabetes Institute
Please provide answers to the questions below. Your information will be entered into our database, so that researchers may contact you about participation in future clinical research studies at the Alberta Diabetes Institute.

Protection of Privacy Statement - The personal information requested on this form is collected under the authority of Section 33 (c) of the Alberta Freedom of Information and Protection of Privacy Act and will be protected under Part 2 of that Act. It will be used for the purpose described above. Direct any questions about this collection to: Alberta Diabetes Institute Clinical Research Unit, 2-004 Li Ka Shing Center for Health Research Innovation, 780-492-6464.

First Name
Your answer
Last Name
Your answer
Phone number
Your answer
Email address
Your answer
Medical conditions (check all that apply)
Optional field: helps our researchers better match you to studies
Interested in (check all that apply)
Optional field: choose the types of studies that you are interested in
Your answer
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