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Consent Documents

Please review the following documents that explain our research study.

Please DO NOT print these forms and send them to us without FIRST registering.

You will NOT be in our system unless you register or contact us at (773) 702-0829.

NOTE: You will need Adobe® Reader® to view the PDF documents below, which can be downloaded free HERE.

If you are an ADULT (18 years or older) diagnosed with diabetes under 1 year of age:

1. MAIN NEONATAL REGISTRY CONSENT FORM
2. CONSENT FOR PARTICIPATION IN ONLINE DISCUSSION GROUPS
3. MEDICAL RECORD RELEASE FORM

 

If you are a parent/guardian of anyone diagnosed with diabetes under 1 year of age:

1. MAIN NEONATAL REGISTRY CONSENT FORM (Parent signs under “Parent/Guardian.”)
2. CONSENT FOR PARTICIPATION IN ONLINE DISCUSSION GROUPS
3. MEDICAL RECORD RELEASE FORM
4. ASSENT FORM (Must be completed if child is currently 7-11 years old.)

 

If you are an adult OR a parent/guardian of someone diagnosed with diabetes after 1 year of age:

1. MAIN NEONATAL REGISTRY CONSENT FORM

Physicians: Please review all consent documents above so you may understand the study for discussion with your patients. You should not sign any of these forms or consent the patients yourself for participation. Consent must be obtained by approved study staff only. Please review the Physician Discussion Group Consent (sign as the “Subject”), if desired.