Hospital Operations Research Publication Consent Form
Please complete this form to provide your consent for the publication of hospital operations research findings.
Full Name
*
First Name
Last Name
Email Address
*
example@example.com
Phone Number
Please enter a valid phone number.
Hospital/Department Affiliation
*
Role in Research (e.g., Patient, Staff, Collaborator)
*
Please Select
Patient
Hospital Staff
Research Collaborator
Other
Title of Research Study
*
Date of Consent
*
-
Month
-
Day
Year
Date
Additional Comments or Questions (optional)
Signature
*
Submit Consent
Submit Consent
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