[MIU Web Site Links][Self Care Articles: Clinical Trials]


Clinical Trials Registry Form

To be placed on the MIU registry, please complete the following information. We can not guarantee that this information will help you to enroll in future clinical trials; however, we will make this database readily accessible to qualified medical researchers.

 Nature of illness:

Name:

Address:
AM Phone:
PM Phone:
FAX :
E-mail:

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Revised: May 07, 1999.