To join our participant list, you'll need to fill out an online enrolment form. If you'd like to see all the questions you'll have to answer, they are listed below.
Contact Information
Please provide your contact information. Questions marked with a star (*) are required.
* Name (first, last)
Personal E-mail
* Primary Phone Number: ( ) - ext.
* Primary Phone Number is: ? Home ? Cell ? Work ? Other, specify:
* Can we leave a message at the primary phone number? ? Yes ? No
Best time to call at the primary phone number:
9 am – 12 noon
12 noon – 5 pm
5 – 8 pm
Other, specify:
Alternate Phone Number: ( ) - ext.
Alternate Phone Number is: ? Home ? Cell ? Work ? Other, specify:
Can we leave a message at the alternate phone number? ? Yes ? No
Best time to call at the alternate phone number:
9 am – 12 noon
12 noon – 5 pm
5 – 8 pm
Other, specify:
Mailing Information:
Address: Apt/Unit:
City: Postal Code:
Personal Information
Tell us about yourself.
Please complete the following questions. Your answers will help researchers identify individuals who are eligible for CAMH studies. The more information you provide will increase the ability of researchers to match you to suitable studies.
Questions marked with a star (*) are required.
Where did you learn about the CAMH Research Registry?
CAMH.ca website
Flyers/posters at CAMH
My CAMH clinician or clinic staff
Participated in a CAMH research study
Word of mouth from a friend, family member
Unknown
Decline to answer
Other, specify:
* Date of Birth (dd/mm/yyyy):
* Gender:
Male
Female
Transgender
Transsexual
Unknown
Decline to answer
* Ethnicity:
Aboriginal
Asian: East (e.g., China, Japan, Korea)
Asian: South East (e.g., Cambodia, Laos, Indonesia, Vietnam, Malaysia, Philippines)
Asian: South (e.g., India, Pakistan, Sri Lanka)
Black: Caribbean
Black: African
Black: North American
Indian: Caribbean (E. Indian)
Latin American
Middle Eastern
Mixed Background
White – European
White – North American
Unknown
Decline to answer
Other, specify:
* Education (highest grade/degree):
None/Grade school (JK to 8): some/completed
Secondary school (9-12/OAC/GED): some/completed
Post-secondary (college/university): some/completed
Unknown
Decline to answer
* I am/was a client/patient of CAMH (or the Clarke Institute of Psychiatry, Queen Street Mental Health Centre, Addiction Research Foundation, and/or Donwood Institute):
Yes
No
Unknown
Decline to answer
* Have you ever been seen, diagnosed or treated by a health professional for an emotional/psychiatric, substance use, or addiction problem?
No
Yes
Unknown
Decline to answer
If yes, what was the problem? (e.g., depression, anxiety, schizophrenia, gambling, alcohol, cocaine, nicotine, etc.)
* Have you ever taken medication for the treatment of an emotional/psychiatric, substance use, or addiction problem?
No
Yes
Unknown
Decline to answer
If yes, what was the medication(s)?
* Have you used recreational drugs (e.g., cannabis, cocaine, etc.) in the past 3 months?
No
Yes
Unknown
Decline to answer
If yes, what was the recreational drug(s)?
* Have you smoked at least 10 cigarettes a day in the past 3 months?
No
Yes
Unknown
Decline to answer
Ready to enroll? Complete the online form.
Protecting Your Privacy
CAMH is committed to protecting your privacy. The information gathered as part of any CAMH study or through the CAMH Research Registry is managed, stored and protected by CAMH in accordance with Ontario law. If you are in a treatment study, your clinical information will be stored in our e-Health Record system, accessible only to the health care team directly involved in your clinical care, as well as the research team.
If you have any questions or concerns about the confidentiality of your information, you may contact us by emailing [email protected] or by phone at 416 535-8501 ext. 31630. Further information may be obtained through the CAMH Privacy & Information Office.