De-Identified Tissue Consent Intake Form

Principal Investigator/ Faculty/ Resident/ Student

Please provide your email

Do you have an IRB approved study? (optional)

What kind of samples do you need to collect?

Is this tissue taken out during dental treatment and not needed for diagnosis or care?

Would this tissue be considered excess tissue and typically be disposed of as medical waste?

How many units of samples in aliquots/ cryovials will you need to collect?

Over how long do you need to collect this? (months)

What data are you collecting?

Have you completed any CITI program trainings?

Do you have experience obtaining informed consent?

Comments

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