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Duke Pulmonary Medicine | Healthy Volunteer Database

Duke Pulmonary Medicine is currently recruiting healthy male and female volunteers (18 years of age and older) who would like to be included in a Healthy Volunteer Data Repository with the department of Duke Pulmonary Medicine.

All volunteers should be in excellent health and not have anemia or significant lung or heart disease.

The Healthy Volunteer Data Repository is a central place in which we keep a list of healthy volunteers who have expressed interest in Pulmonary Medicine research studies. Once added to our Healthy Volunteer Data Repository, we will send you information about future studies we think would be a good match for you.

The survey below will ask you a few basic questions to assist us in contacting you to inform you about future studies and to confirm you meet certain study criteria. If you prefer, we can also ask you the survey questions over the phone and complete the survey for you.

Completion of this survey will indicate your consent to participate in the Healthy Volunteer Data Respository for Pulmonary Medicine.

Completion of the survey also means that your information will be seen by members of Pulmonary Medicine research team. The only risk to you is the risk of loss of confidentiality. However, all of the individuals who will see your information are trained professionals who work with healthcare information daily and are aware of the importance of maintaining confidentiality of health records. Your personal Information will be stored securely and can be withdrawn at any time.

For questions or more information please call the Duke Airway Research group at 919-479-0861.

To be included in our Healthy Volunteer Data Repository for Pulmonary Medicine, please complete the survey below.

Thank you!

Todays Date

* must provide value

M-D-Y

First Name

* must provide value

Last Name

* must provide value

Date of Birth

* must provide value

M-D-Y

Age

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Preferred Phone Number

* must provide value

Preferred Email Address

Street address or PO box number

City

* must provide value

State

* must provide value

Assigned sex at birth

* must provide value

Female

Male

Duke Pulmonary Medicine | Healthy Volunteer Database

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