Volunteer Registration

Clinical Trial is conducted to investigate the effects of new treatments in human volunteers. Participating in a clinical trial can help contribute to potential new treatment in human, which would benefit the public. If you are interested in future clinical trials, please complete the following questions:

1. Do you have any pre-existing medical conditions?

YesNo

2. Are you currently on any medication? If yes, please indicate:

YesNo

3. Do you have any drug allergy?

YesNo

4. Have you participated in any clinical trial before?

YesNo

5. Are you currently participating in any clinical trial?

YesNo

6. Are you currently pregnant or breastfeeding?

YesNo

7. Can we contact you for future studies?

YesNo

I attest that the information I have provided is accurate and complete to the best of my knowledge. By filling and signing this form, I consent to the collection, use and storage of the above information by Singapore General Hospital, Clinical Trials and Research Centre. This information will be kept confidential as per institution's policy.

I acknowledge I have read and understood the statement above