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WzfNbxApRW85MDUKwoInQ9YJsyKIKISw7YHDsjcHunEEuwqrcBdgAmWXD4tFyxfT2NwyYFsisyh5HAyCP7SyesA45XvnoMGCiPHdeyjSaHmaHDVed8MwBsTV9

SPECIALIZING IN NOVEL AND INNOVATIVE RESEARCH APPROACHES FOR ALL TYPES OF CLINICAL DEPRESSION

Thank you for your interest in our Clinical Studies. Our study participants are essential in the research for new and effective depression treatments.

Click here to visit the Depression Research Clinic website

Thank you for your interest in our clinical studies. Please select the study or studies in which you are interested in participating or learning more about. You may choose more than one study.

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Other Study Not Listed or Interested in Having Information on File for Future Studies

Opiate Ketamine study only

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If applicable, please give a brief description of the unlisted study you are interested in participating or indicate if you are entering your information to be contacted for future studies:

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CONTACT INFORMATION

Thank you for your interest in our clinical studies. We would like to know a little about you. Please fill out some basic information and we will be in contact with you shortly.

What is your first name?

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What is your last name?

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What is the best phone number to reach you?

* must provide value

Home phone

Cell phone

Work phone

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Can we leave messages for you at this phone number?

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Yes

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What is your email address?

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Do you prefer to be contacted by phone or email?

Phone

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What is the best time to call?

How were you referred to this study or how did you find out about this study?

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Thank you for your interest in participating in our studies!

Please read through the brief descriptions of our current studies. This will walk you through the procedures that are involved so that you will have a complete understanding of the timeline. When you have finished reading the description, please continue to the online consent below. Acknowledgement of reading the study description does not obligate you to a particular study. This consent is only obtaining your permission to gather some basic health information. This basic information will assist us in determining eligibility for our studies. You must be at least 18 years of age to complete our online screening process.

The survey is given in two parts. The first survey will collect some basic demographic, medical, and psychiatric history, as well as assess current mood. The second survey will be emailed out after completion of the first and will collect some safety information and medication history.

After completion of the survey, we will contact you to inform you of your eligibility.

We look forward to discussing your eligibility shortly.

STUDY SCREENING CONSENT FORM

PROCEDURES

For this initial screening, with your permission, we would like to collect health information about you, including information about your general health (current mood states, family history, general medical conditions, medications, therapy, alcohol and substance use, height, weight, etc.) related to medical treatments and care you receive.

RISKS AND BENEFITS

There are no anticipated risks associated with this screening. You will not receive any direct benefit from participation. We cannot and do not guarantee or promise that you will receive any benefits from this screening.

TIME INVOLVEMENT

Your participation in this survey is self-timed, and usually takes anywhere from 30-60 minutes. Soon after completion (usually 1-2 weeks) we will contact you regarding your eligibility.

PAYMENTS

You will not be paid to complete this survey.

PARTICIPANT'S RIGHTS

If you have read this form and have decided to participate in this survey, please understand your participation is voluntary and you have the right to withdraw your consent or discontinue participation at any time without penalty or loss of benefits to which you are otherwise entitled.

The results of this screening may be presented at scientific or professional meetings or published in scientific journals. However, your identity will not be disclosed. You have the right to refuse to answer particular questions.

You have selected an option that triggers this survey to end right now.

To save your responses and end the survey, click the 'End Survey' button below. If you have selected the wrong option by accident and/or wish to return to the survey, click the 'Return and Edit Response' button.