Register Your Interest

HOW IT WORKS

When registering your interest as a research volunteer, you will be asked simple questions about yourself or the individual you are registering. This includes address, date of birth, and a brief medical history.

Registering your interest takes 5 minutes. It does not commit you to participate in the research, and it is simply an indication that you might be interested in doing so in the future. If you are registering on behalf of someone else, please ensure you have their permission to do so and enter their details (for screening purposes).

You can register online or call our Clinical Trials Team on (08) 9389 6433, and our friendly and supportive staff can answer any questions and help register you over the telephone.

After completing registration, you will receive correspondence from our Clinical Trials Team about your eligibility.

If you are eligible for a current study, our team will then provide detailed information about the study, and you will have the opportunity, only if you wish to do so, to answer any further screening questions. You may ask as many questions as you like. You can then decide if you want to take part and can stop taking part at any time.

If you are ineligible, with your permission, we will keep your details on file and reach out to you if you become eligible for any future research programs.

Research participation is entirely free for all volunteers.

Note: Some research studies are funded to support participation by providing a small token of appreciation or covering some of the costs of being involved, such as travel, but this varies depending on the study.

By completing this form I give the Australian Alzheimer's Research Foundation permission to use and retain this information to contact me for future research opportunities.

Full Name*
Date of Birth*
Phone Number*
Email*
Address
What is your gender?
Does the interested individual have study partner who can assist with appointments and provide feedback to the study team?

A study partner is someone who is willing to participate in the visits with you. Please note, that this is not a requirement for all research programs.
Has the interested individual been diagnosed with Alzheimer's disease or another form of dementia?*

If yes, what was the diagnosis and when did it occur? Example: Alzheimer's disease, diagnosed mid-June 2020.
Has the interested individual had cancer within the past 5 years?*
Does the interested individual have a history of epilepsy/loss of consciousness within last 10 years?*

If yes, please provide details.
Does the interested individual take any approved or investigational medications to treat Alzheimer's disease?*

If yes, please provide details.
Does the interested individual have a family history of Alzheimer's disease?*

If yes, please provide details.
Phone
This field is for validation purposes and should be left unchanged.