Lakeland Clinical Trials Wellington

Based in the Upper Hutt Health Centre, LCT Wellington is the most recent addition to the LCTG and PCRN networks.

Providing access to the wider Wellington region, the addition of this latest site significantly enhances the network’s coverage by adding one of the main New Zealand population centres.

Volunteer Registration Form

Thank-you for taking the time to register as a volunteer.

Please complete the form below with as much information as possible.

The information we collect will help us to determine if you are suitable for any of our current studies or if we need to contact you to collect additional information.

You are more than welcome to register as a volunteer even if you aren’t eligible for one of current studies.

Fields marked with * are required.

First Name

Last Name

Your Email

Mobile

Address

Date of Birth

Gender

Current Studies

Are you interested in any of our current studies?

If yes, please detail which of our current studies you are interested in?

Medical Information

Do you have any current medical conditions?

Other Information

If other, please specify:

Terms & Conditions

Authorisation

Please note that by completing the above form and accepting the terms & conditions below, you are confirming and agreeing to the following:

You have read the Clinical Trial Information and Volunteer Database information on this website.
You understand that your information will be securely stored in a database held by SCTG clinical research centres.
Your information will only be accessed by authorised SCTG clinical research staff.
Your information will be stored for the purpose of allowing SCTG clinical research centres to notify you about current or future trials you may be suitable for.
You have no obligation to be involved in any trial.
Providing your information is entirely voluntary.
You can access your information at any time or request to have it corrected.
If you wish to have any information removed you will need to contact the applicable SCTG research centre with your request.
You agree to your personal information being collected for the use of the above Volunteer Database.