Acclaim Clinical Research

COVID 19 & Influenza Site Registration Consent Form

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Patient Consent

I understand that I will be receiving marketing text messages, emails, and phone calls from Acclaim Clinical Research staff. I understand that I am providing consent for optional complementary services that may be offered by Acclaim Clinical Research (in its sole and absolute discretion) or that I have requested and as agreed to by Acclaim Clinical Research. I also understand that the medical conditions, medications, and demographics that I have provided will be added to the Acclaim Clinical Research patient database. By signing below, I agree that I have reviewed and agree to the Acclaim Clinical Research privacy policy attached to this consent form and that I acknowledge the opt-out provisions set forth in the privacy policy.

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Signature Certificate
Document name: COVID 19 & Influenza Site Registration Consent Form
lock iconUnique Document ID: 27dff41a3f57b399a30f16bd713d53604d665b82
Timestamp Audit
December 3, 2021 10:41 am PDTCOVID 19 & Influenza Site Registration Consent Form Uploaded by Kun Chap - [email protected] IP
May 26, 2023 9:51 am PDTAcclaim Recruitment - [email protected] added by Kun Chap - [email protected] as a CC'd Recipient Ip: