Study Title: Department of Neurology Research Recruitment Database
Principal Investigator: Enrique Alvarez, MD
COMIRB No: 17-1313
Version Date: 13Oct2021

The Department of Neurology has a research database which we maintain for the purpose of contacting individuals for future clinical research studies. Would you like to be included in this database?

If you agree, we will keep some information about you in our research recruitment database. The information that will be kept may include: your name, medical record number (if applicable), demographic information, contact information, and basic health information including diagnoses and medications.

When there is a research study avaliable that you might qualify for, research staff will try to contact you by phone, email, or mail. They may attempt to contact you up to 3 times.

This information will remain in the database indefinitely or until you request that it be removed.

The only possible risk to putting your information in this database is the possibility of loss of confidentiality of your protected health information. Every effort will be made to protect your privacy and confidentiality. This database is kept on a secure server at the University of Colorado Denver and the only people who will have access to this information are doctors doing research in the UCD neurology department and their study staff. This information will not be shared with anyone outside these research teams and will only be used to access your eligibility for and contact you about future research studies.

You have a choice about having your information kept in this database. You do not have to participate if you do not want to.

If you have questions, you can call the Neurology Clinical Research Recruitment line at 303-724-4644 and a researh coordinator will call you back. You can call to ask questions at any time.

You may have questions about your rights as someone in this study. If you have questions, you can call COMIRB (the responsible Institutional Review Board) at (303) 724-1055.