Clinical Research Trial Information Request Form

Clinical Research Trial Information Request Form

5232 East Freeway, Baytown, Texas 77521 - (833) 428-7348
Please note this form is HIPAA Compliant.

Thank you for your interest in partnering with EduCURE Nonprofit Organization. We are dedicated to engaging underrepresented communities through comprehensive clinical research education. Our mission is to improve health outcomes by increasing community participation, addressing health disparities, building trust, fostering advocacy, creating career pathways, and supporting culturally relevant research initiatives.

For more information, please visit our website at www.educureactnow.org or contact our office at (833) 428-7348.
Please complete all required fields in this form and submit it. Once received, a member of our team will contact you promptly.
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Are there any specific clinical trials you would like additional information about?*
If so please input the clinical trial information you would like to know more about.
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Consent to Receive Information and Release, Indemnity, and Hold Harmless Agreement I hereby consent to receive information and communications from EduCURE Nonprofit Organization, located at 5232 East Freeway, Baytown, Texas 77521, and to be contacted by its authorized representatives at the phone number 833-428-7348 regarding Clinical Research Trial Information. I acknowledge that, upon my request to participate in EduCURE’s programs or campaigns, EduCURE will facilitate my connection with a designated clinical research site to obtain further information about the trial. I understand that my participation in this process is voluntary. By signing below, I release, indemnify, and hold harmless EduCURE Nonprofit Organization, its officers, agents, and affiliates from any and all claims, liabilities, or damages arising from or related to the receipt of information, my participation in the program, or my engagement with the clinical research site.
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