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Participation in Research for Unified Life Sciences

The following information is being provided to you in order for you to be as informed as possible about the research in which you have been asked to participate. If you have any questions regarding this information, or any aspects of this study, please feel free to ask your questions to the chief investigator of this project before you complete this form.

Chief Investigator
Eleanor Haspel-Portner, Ph.D.
Unified Life Sciences
ehp@unifiedlifesciences.com
(310) 230-7787

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Purpose and Benefits

The purpose of this research is to evaluate and examine the value of Multidimensional Design information. This research may provide information that could enhance the health and well-being of many people, including you and your children. We need information on as many individuals as possible for general and specific population studies.

We also need birth data information on individuals who are interested in being included in our data analysis studies of design but who may not be able to participate in group pilot studies or in-person studies. We appreciate all the birth and health data we receive because it improves our statistical analysis reliability.

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Safeguards

Your participation in this study is purely voluntary. The information obtained about you (as well as every other participant in this study) will remain anonymous and will be examined in terms of group findings. None of the information obtained about you shall be released to any third parties.

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Possible Risks

This study has no known risks. The Multidimensional Design Information has been utilized by thousands of people throughout the world for better understanding of themselves, their families and their health. The only risks may come from deeper understanding of yourself and what that can bring to you.

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Summary Report

At the conclusion of this research project, a summary report containing the results and outcomes of the study will be made available for review to the participants involved. If you would like to receive a copy, please submit an email address to which a copy can be sent.

Participation Form

Name, Address, Phone and Email
Name:
Address 1:
Address 2:
City:
State/Province:
Zip/Postal Code:
Country:
Email:
Phone:

Birthdata
Birth Date: Month: Day: Year: Sex:
Birth Time: Hr: Min: Sec: AM/PM:
Birth Place City:
Birth Place State/Province:
Birth Place Country:

Medical Conditions (Diagnosis)

Participation Interest

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Contact Us

Unified Life Sciences

A Multidimensional Approach to the Health of Body, Mind, and Spirit
Phone: (310) 230-7787

ehp@unifiedlifesciences.com

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Revised: Monday, September 12, 2011
http://www.unifiedlifesciences.com/partform.html
email:webmaster@unifiedlifesciences.com