Belong clinical trial search request form
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.