Research volunteer sign-up form https://www.chelwest.nhs.uk/about-us/research-innovation-and-quality-improvement-riqi/research-development/patients-and-public/research-volunteer-sign-up-form https://www.chelwest.nhs.uk/++resource++plone-logo.svg Research volunteer sign-up form User email: Please leave this blank!!! Contribute to research The Chelsea Clinical Research Facility (CRF) at St Stephen's Centre, part of Chelsea and Westminster Hospital NHS Foundation Trust, is a world-renowned centre for clinical research. We support high-quality clinical trials that advance medical knowledge and drive innovation. We’re inviting volunteers—both patients from our hospitals and healthy individuals—to join our database and contribute to research studies, if eligible. How it works Register with our database to receive information about upcoming research opportunities Your participation is always your choice—deciding not to take part will not affect your care Compensation for time and expenses may be available for some studies (varies by trial) Opt out anytime—you’re free to withdraw at any point Stay informed Once registered, you’ll receive details about upcoming research projects and can choose whether to get involved. Your information will be securely stored and accessible only to the CRF team. Get in touch For more information, contact us:T: 020 3315 6561E: chelwest.researchvolunteers@nhs.net Register now About you First name Surname Date of birth Gender assigned at birth Male Female Intersex Undetermined We understand this can be sensitive information. This refers to the gender recorded on your birth certificate at birth, which may not align with your gender identity. Gender identity Male Female Non-binary Prefer to self-describe Prefer not to say I self-describe my gender as: Ethnicity Asian/Asian British - BangladeshiAsian/Asian British - IndianAsian/Asian British - PakistaniAsian - any other Asian backgroundBlack/Black British - AfricanBlack/Black British - CaribbeanBlack - any other Black backgroundMixed - White and AsianMixed - White and Black AfricanMixed - White and Black CaribbeanMixed - any other mixed backgroundWhite – BritishWhite - IrishWhite - any other White backgroundOther - ChineseOther - any other ethnic group Height in cm Use whole numbers—ie 176, not 175.5 Weight in kg Use whole numbers—ie 80, not 79.5 NHS number If known Contact details Preferred method of contact Email Mobile phone Post You can choose more than one. Email address Mobile number Address line 1 Address line 2 City County Postcode Medical conditions I have a chronic illness or medical condition If ticked, please provide details including current medications and/or treatments Allergies I have a known allergy If ticked, please provide allergy details Smoking I currently smoke If ticked, how many cigarettes or equivalent per day Alcohol I currently consume alcohol If ticked, how many units per week Physical activity I currently engage in regular physical activity If ticked, please provide activity details Source of referral How did you find out about the research volunteer database Chelsea and Westminster website Chelsea and Westminster intranet Facebook Instagram Friend or work colleague Google Newspaper Word of mouth University fair GP practice Other If other, please specify Consent I consent to being contacted regarding clinical studies Submit About research volunteer database consent Your responses, along with any future responses, will be securely stored in an electronic database accessible only by the Chelsea Clinical Research Facility (CRF) team. If you wish to withdraw your consent for us to use this information, you may do so at any time. Once your records have been deleted, we will no longer be able to contact you about future research studies. However, you are still welcome to respond to adverts and participate in studies independently. To request removal from the database, please contact us using the details below and clearly indicate your wish to be removed:T: 020 3315 6561E: chelwest.researchvolunteers@nhs.net