Consent for TrialSpark Program Enrollment
Last updated November 17, 2016
TrialSpark has developed a program that connects patients to the research studies and clinical trials (“Studies”) appropriate to their diagnoses or conditions (the “Program”). When you provide you or your child’s personally identifiable information (“PII”) to TrialSpark in connection with the Program, TrialSpark may make that information available to researchers, trial sponsors, and pharmaceutical companies and other entities (“Researchers”) who are conducting Studies in which you may be able to participate if you meet the applicable requirements.
By signing up for the Program and agreeing to this consent form, you are authorizing TrialSpark and its affiliates to:
- Collect and store you or your child’s PII, which may include you or your child’s name, email, phone number, contact information and other personal information that you may decide to provide;
- Use your email and phone number to contact you;
- Send you, via email, health-related surveys that will ask you to submit information to TrialSpark including, but not limited to, you or your child’s age, gender, smoking status, diagnoses, medical conditions, medical history, medications, and healthcare-related information (“Health Information”);
- Store the Health Information you submit in those surveys along with you or your child’s PII in TrialSpark’s database;
- Share you or your child’s PII and Health Information with Researchers who may contact you directly to invite you to participate in Studies.
Consent Form Information
- You have the right to revoke this consent and may opt out of the Program at any time by notifying us in writing by sending an email to email@example.com. However, please note that the revocation will not apply to the extent that TrialSpark has already released your or your child’s information to Researchers based on this consent.
- If you revoke your consent by opting out, it will take effect as soon as your selection is received by TrialSpark, and will apply to Studies that are not already in progress.
- TrialSpark may receive compensation for making your or your child’s information available to Researchers.
- Your or your child’s participation in the Program is voluntary, and you may refuse to agree to this consent. If you don’t agree to this consent, you or your child will not be able to participate in this Program.
- This consent will expire 5 years from the date you agree to this consent.
- You may request a copy of this consent by sending an email to firstname.lastname@example.org.