Belong clinical trial search request form

I would like Belong to search in existing clinical trials lists, examine and update me for possible clinical trials that may be relevant to my current status or whom I am authorized by to request this for. Therefore, I will attach the following details including medical case details, especially recent summaries and updated status reports (Note: please attach documents after deleting any identifying details). I acknowledge that this service is provided according to the Terms of service and Privacy policy of Belong.

I acknowledge that the requested search is done by an electronic and manual scanning of the provided details and documents and that the information may be used by Belong to search for relevant clinical trials for me (or for whom I am authorized by to request this for) and for other research purposes. I acknowledge that there is no guarantee that Belong will succeed in finding a relevant clinical trial and no guarantee that I will enrolled in a relevant clinical trial by a hospital or other third party. In addition, Belong will make an effort but cannot guarantee to update me with the results of this search, to examine possible clinical trials or to achieve any achievements. By using this service, I hereby agree to the above terms and thereby waive in advance any claim and/or demand and/or legal suit of any kind towards Belong relating to this Service.

I authorize Belong to contact me directly, if necessary.

    NOTE: If you are not a member in Belong.Life yet, download the app HERE (it's free), register, and continue with this form, or alternatively, go into the "find clinical trials" group in the app

    * All according to the Terms of service and Privacy policy of Belong.