Jain Foundation Communication Consent Form for Family

Jain Foundation Communication Form for Family

HomeCommunication Consent Form for Family

  • In the event that we need to communicate with your family to discuss information pertaining to your muscular dystrophy, the Dysferlin Registry or to coordinate logistics for a research study, we request that you give both the Jain Foundation and your family members permission by completing and signing this Communication Consent Form. Thank you
  • MM slash DD slash YYYY
  • First Family Member

  • Second Family Member

  • Third Family Member

  • If you would like a copy of this completed form sent to you, please provide your email in the email field below.