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Project
About RDBCOV
News&Events
Media corner
RBDCOV Talks
Documentation
Contact

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Recruitment form Spain

Over 18 years old

Contact form SPAIN / +18

Δ

First Name

Surname

Email

Centre where you want to participate

Age

Do you consider yourself to be at the same risk as the rest of the population for SARSCoV-2 infection?

Yes

No

Have you received a full mRNA-based COVID-19 vaccine (Pfizer, Moderna) at least 6 months ago?

Yes

No

Are you able to comply with visits schedule, complete diaries, provide samples and other study procedures?

Yes

No

Are you able to grant authorized people access to his/her trial-related medical record and GP records either directly or indirectly?

Yes

No

Are you an immunocompromised individual?

Yes

No

I have read and agree to the Terms and Conditions and Privacy Policy

Under 18 years old

Contact form SPAIN / UNDER 18

Δ

First Name

Surname

Name and surname of legal representative

Email

Centre where you want to participate

Age

Is the possible patient between 2 and 18 years?

Yes

No

Has the patient not yet received any doses?

Yes

No

Do you agree with signing the informed consent?

Yes

No

Are you able to comply with visits schedule, complete diaries, provide samples and other study procedures?

Yes

No

Are you able to grant authorized people access to his/her trial-related medical record and GP records either directly or indirectly?

Yes

No

I have read and agree to the Terms and Conditions and Privacy Policy

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