Become a Volunteer

Consent to Contact for Clinical Trial Participation

4 Medical Clinical Solutions (4MCS) is an organisation committed to the development of new medical devices and medicines for human health. The focus of 4MCS is to conduct clinical trials (research studies) for novel medicines in connection with major pharmaceutical companies. There are numerous diseases that require effective and safe medicines to treat them. Conducting clinical trials are vital for the development of new medicines.

People taking part in clinical trials are important to evaluate the effectiveness and safety of new drugs. From time to time, 4MCS would require people with specific diseases to take part in clinical trials during new drug development. If you would like 4MCS to contact you for future research, please complete the form below and the 4MCS team will be in touch with you.

Why have I been chosen?

You are suffering from a specific illness. If there is a clinical trial which requires people with your diagnosis to participate, 4MCS will contact you to invite you to take part in the research.

Do I have to take part?

Clinical Research in diabetes is now on-going. If you are diabetic you may be eligible to take part in this study. For further information contact us.

Will my taking part in this project be kept confidential?

All data will be identified only by a code, with personal details kept in a locked file on a secure computer with access only by the immediate research team.

Name of Participant

First

Last

Date

Postcode

Mobile

Telephone

Information Sheet Confirmation

I confirm that I have read and understood this information sheet. I have had the opportunity to consider the information.

Participation Confirmation

I understand that my participation is voluntary and that I am free to withdraw at any time without giving any reason and without my medical care or legal rights being affected.

Data Permissions

I understand that relevant sections of my medical notes and data collected whilst entering the registry and during future studies, may be looked at by individuals from 4MCS or dedicated research team members, from regulatory authorities, or from an NHS Trust, where it is relevant to my taking part in clinical research. I give permission for these individuals to have access to my records.

Personal Information

I understand that all personal information will remain confidential and that all efforts will be made to ensure I cannot be identified (except as might be required by law).

GP Confirmation

If appropriate, I agree to my General Practitioner being informed of my participation in the study. I agree to my General Practitioner being informed of the study, including any necessary exchange of information about me between my GP and the research team.

Confirm

I agree to my name being entered onto the 4MCS register.

Future Contact

I agree for 4MCS to contact me in the future about specific clinical trials.