COLLECTION CONSENT FORM

George Clinical maintains a Database of Research Professionals (Database) who may be interested in potential future collaborations with us.

If you like to understand the types of Personal Information we collect from you, why we collect it, and how it will be stored, used, disclosed and transferred in relation to that Database please refer to the Notice below:

Personal Information Collection Notice -

Click here

Please also see our

Privacy Policy

By completing this form and ticking the attestation boxes below, you are confirming agreement to George Clinical collecting, storing, using, disclosing and transferring your personal information, in accordance with this notice and consent.

First Name

Last Name (Family Name)

Phone Number

Email address

Select your country :

Role Title :

Investigator

Study Coordinator

Site Staff

Other

Declaration and Consent

I understand how My Information will be managed and wish to join George Clinical’s Database of Research Professionals.

I understand that My Information may be transferred across international borders and that George Clinical will take steps to ensure adequate protections are in place.

OR

I decline consent to join George Clinical’s Database of Research Professionals.

Note, if you do not want us to contact you for future opportunities, we will note this, along with your Name and email address on file, to prevent you from being contacted again in the future by GC.

customerservice@georgeclinical.com

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