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4dBDYbXhvN7CrCRWzqZD

NIHR BioResource - Expression of interest

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Thank you very much for your interest in joining the NIHR BioResource. We are very keen to attract new volunteers and really appreciate your offer to help.  Before completing this expression of interest form please read our Participant Information Sheet.

Please note that this form is for the recruiment of people aged 16 and over. If you are interested in D-CYPHR, our research project for children, please see our website.

If after reading the Participant Information Sheet you are interested in joining the NIHR BioResource please complete the form below. We will use the information from this form to arrange for you to provide a sample and complete the required consent form and health and lifestyle questionnaire. Samples can either be given in person at one of our local centres (blood sample) or, if you are unable to travel or do not live close to a local centre we can arrange for you to provide a saliva kit from home. If you do not decide to join the BioResource this information will be deleted.

You can change your mind at any time without giving a reason.

If you would prefer to speak to us about joining the BioResource before filling out this form please email us at nbr@bioresource.nihr.ac.uk.

Please tick to confirm that you have read the Participant Information Sheet and would like to join the BioResource, you are free to change your mind at any time. A copy of the Information Sheet will be given to you for your records when you consent to join the BioResource.

I confirm I have read the Participant Information Sheet and would like to join the BioResource

First Name

* must provide value

Surname

* must provide value

Date of birth

* must provide value

D-M-Y

Address:

* must provide value

Address line 2

Town

Postcode:

* must provide value

Phone number

Email address

* must provide value

Where did you hear about the NIHR BioResource?

* must provide value

We are currently working with Egality Health and a network of partner organisations to engage new volunteers from diverse communities. Were you connected to us (directly or indirectly) via one of the organisations listed here?

* must provide value

If you heard about us at an event or somewhere not listed in the options above, please provide more details

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We recruit participants from the general public as well as patients with common and rare diseases. If you have one of these conditions or a rare disease please let us know and our recruitment team will be in touch to see whether we can recruit you at your local hospital.

* must provide value

Inflammatory bowel disease

Immune mediated inflammatory diseases (including Rheumatoid arthritis, Lupus,PSE)

Non-alcoholic fatty liver disease

Rare disease

None of the above

A member of our recruitment team will be in touch to discuss whether we can recruit you to the BioResource at your local hospital.

The NIHR BioResource has centres across England that offer appointments to provide a blood sample in person and complete the necessary paperwork. If you are happy to provide a blood sample and you are able to visit one of the locations listed below, please select your preferred location and we will pass on your contact details to the local team so they can arrange an appointment for you at a convenient time.

If you do not live close enough to one of our locations listed below, or you would prefer not to give blood, you can choose to provide a saliva sample from home. Please select that option from the list and we will send you the relevant paperwork and saliva kit to the address you have provided above.

Please choose whether you would like to attend your local centre to provide a blood sample or complete a saliva kit at home.

* must provide value

Thank you for chosing to provide a saliva kit at home. A saliva kit will be posted to you shortly.

Thank you for choosing to provide a sample at one of our local centres, a team member from your chosen centre will be in touch to arrange an appointment for you.

Thank you for choosing to provide a sample at Addenbrooke's hospital in Cambridge. Appointments can be offered at our clinical facility Monday - Friday any time between 9am and 2pm. Please answer the following screening questions to help us determine whether you are currently able to give a blood sample. Regardless of your answers, you may still be eligible. Our team will be in touch to confirm your appointment and to discuss any queries.

Are you fit and well at the moment?

Yes

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Please provide further details

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Is there any possibility that you might be pregnant?

Yes

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Have you had any problems providing blood samples in the past? Examples include difficulty finding a vein, fainting, etc.? Please note that the blood sample will be taken from your arm.

Yes

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Please provide further details

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Have you recently had any vaccinations, antibiotics, illnesses or investigations?

Yes

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Please provide further details

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Are you a blood or platelet donor?

Yes

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Are you currently taking any medication?

Yes

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Please provide further details

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Please let us know of any specific requirements that should be considered when you attend your appointment (i.e. limited mobility, blue badge parking, or accompanying children)

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Do you have a preferred time/date for the appointment? Appointments are offered between 9am and 2pm Monday - Friday, appointments outside this time may be availble upon request. Travel expenses will be reimbursed

You have selected an option that triggers this survey to end right now.

To save your responses and end the survey, click the 'End Survey' button below. If you have selected the wrong option by accident and/or wish to return to the survey, click the 'Return and Edit Response' button.