AKU COVID-19 Vaccine Clinical Trial

Thank you for your interest in the clinical trial.

The purpose of this survey is to create a list of volunteers who can take part in​ the current and future COVID-19 vaccine clinical trials. You must be 18 years or older to participate. This short online survey includes some personal questions and your participation is voluntary.

All information provided in this form will remain confidential, will only be accessible to the investigators, and will not be used for any other purpose. Agreement to participate in a vaccine study does not guarantee you will be selected to receive the vaccine. You may also withdraw from this database of volunteers at any point.

Do you have questions? Read our Frequently Asked Questions or watch the video below.​




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If you would like more information, 

please contact the Clinical Trial Units.

Email: ctu@aku.edu 

or ​​​call:​  021 34862330 / 34862332 / 34862335

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Are you interested in volunteering for a COVID vaccine trial
Name
Name is required. Name must be letters only.
Age
Age must be numbers only. Age is required.
Sex
Gender is required.
Phone number
phone number must be numbers only. phone number is required.
Email Address
Email id is required. Email id not valid.
Preferred way of contacting
Please select any option.
Are you on any medications which will lower your immunity?
Please mention.
Are you pregnant?
Are you breastfeeding?