Consent Summary: Registry of Potential Research Study Participants
If you agree to participate in the Registry, we would ask you to provide information about yourself including your birth date, gender, race/ethnicity, UI employee or student status, contact information, and types of research studies you are interested in. If you click the “Yes” box below, complete the information form on the next page, and submit the form, you become part of our REGISTRY.

We will keep information you provide confidential. However, federal government regulatory agencies, auditing departments of the University of Iowa, and the University of Iowa Institutional Review Board (a committee that reviews and approves research studies) may inspect and copy records pertaining to this research.

Only University of Iowa Department of Dermatology individuals who are authorized to have access to the REGISTRY information will have access.  REGISTRY information is kept in a database protected by passwords.  We will keep your information in our REGISTRY for five years. The information you provide for us will only be used for the purpose of contacting you for possible future research. Your contact information will not be sold or distributed to any outside party or institution.

There is no compensation for joining our REGISTRY. There are no known risks from being in this study, and you will not benefit personally. However we hope that others may benefit in the future from studies that may be conducted. Taking part in this research study is completely voluntary. If you decide not to be in this study, or if you stop participating at any time, you won't be penalized or lose any benefits for which you otherwise qualify. If you do not wish to submit your information, close the web browser window without submitting the form.

If you have any questions about the research registry itself, contact Dr. Marta VanBeek at 319-353-6439. If you have questions about the rights of research subjects or research related injury, please contact the Human Subjects Office, 300 College of Medicine Administration Building, The University of Iowa, Iowa City, IA 52242, 319-335-6564, or e-mail irb@uiowa.edu.

If at any time you would like to remove your name from this participant database please send a message to: dermatology-research@uiowa.edu You may print this page for your records. A printer-friendly pdf version is available from a link at the top of this page. If you would like to continue with the registration process, please indicate that you have read the above statement by checking the Yes box below.
I have read the consent summary and agree to the information.   No thanks. Return me to the previous page.