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Participant Registration Form
First Name
*
Last Name
*
Phone Number
*
Email
*
City
City and province, for example Toronto, ON. We use this to find studies near you.
Date of Birth
You can type your date of birth instead of using the calendar, for example Jan 15, 1985.
Sex
*
-None-
Male
Female
Ethnicity
*
-None-
Indigenous (First Nations)
Indigenous (Métis)
Indigenous (Inuit)
Black (African)
Black (Caribbean)
Black (Other Black background)
South Asian (e.g. Indian, Pakistani, Sri Lankan)
East Asian (e.g. Chinese, Korean, Japanese)
Southeast Asian (e.g. Filipino, Vietnamese, Thai)
Middle Eastern (e.g. Arab, Persian, Afghan)
Central Asian (e.g. Kazakh, Uzbek, Tajik)
West Asian (e.g. Turkish, Kurdish, Armenian)
Latin American (e.g. Brazilian, Colombian, Mexican)
White (European, e.g. British, French, German, Italian)
White (Other European background, e.g. Eastern European, Scandinavian)
Other
Diagnosed health conditions? List all
Are you actively taking any medications? List all
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