Register for a Wesley Reasearch Institute Clinical Trial

If you are interested in participating in a clinical trial, please register your interest below. There are many reasons to take part in a clinical trial. The key benefits are:

Playing an active role in your treatment
Gaining access to expert medical care at leading institutions
Being part of new treatments not available elsewhere
Personal satisfaction from knowing you are helping others by improving healthcare practices.

Both healthy participants and people who have been diagnosed with a disease are invited to join our research database. Please complete the registration form below to record your interest in participating in a study.

Name*
FirstLast
Date of Birth*
DD
MM
YYYY
Gender*
- Male
- Female
Email*
Daytime contact number*
After hours contact number*
Address
Street AddressCityState / Province / RegionZip / Postal Code
How did you hear about us?
Agreement*
- I agree to provide my details for the Wesley Research Institute Clinical Trials database. The Wesley Research Institute abides by all relevant Privacy Acts regarding the ethical collection, use, storage and disposal of this information. I am aware that I can remove my details from this database at any time by contacting the Clinical Trials Centre.