Research Studies at Cincinnati Children's: Information for Adult Participants: OCTR
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To learn more about Cincinnati Children's research studies or to enroll yourself in our database to be notified about future studies, please complete and return this detachable response card. An Office for Clinical and Translational Research staff member will contact you after receiving your submission to confirm your information and to talk about any specific research study interests you have for yourself.

1. Please check the following

Please check the following I would like to enter myself into the database for future adult studies. I am at least 18 years old.

2. Please provide us with information about you.

Please provide us with information about you. Name:
Address:
City:
State:
Zip:
Daytime phone:
Evening phone:
Email address:
Birth date:
Gender (male or female):

3. Race/ethnicity (check all that apply):

Race/ethnicity (check all that apply): African American

American Indian

Asian

Caucasian

Hispanic

Latino

Other

4. Comments / Notes:

Comments / Notes:

A staff member from the Office for Clinical and Translational Research may contact you after receiving your submission to clarify your information and to talk about any specific research study interests you have for yourself.

Research Studies at Cincinnati Children's: Information for Adult Participants: OCTRExit this survey

1.

Research Studies at Cincinnati Children's: Information for Adult Participants: OCTR
Exit this survey