Join Our Research Registry

If you think you might be interested in participating in a future research study at Shirley Ryan AbilityLab, we invite you to become a member of our research registry. It’s easy! Just answer some basic questions about yourself and your health history using the questionnaire below, and your information will be entered into our database of research volunteers. If one of our researchers determines you’re a good fit for one of their research studies, they will contact you and tell you all about their study, answer your questions, and let you decide if you’d like to participate.

Completing our form should only take you about ten minutes. All the information you submit to us is confidential, and can only be accessed by authorized members of our research teams; thus there is only a minimal risk of a loss of confidentiality. We are committed to protecting your information, and your privacy is our top priority.

If at any time you change your mind and no longer wish to be included in our research registry, simply send an email to researchregistry@sralab.org, and your information will be removed. If you choose to not participate in our research registry, or later change your mind and ask that your information be removed, you will not be penalized in any way or lose any benefits to which you are entitled, specifically any present or future medical care.

By submitting information through our website you agree and confirm that you are 18 years of age or older and submitting information about yourself, or you are the parent or legal guardian of a person under 18 years of age on whose behalf you’re submitting information.

Applicant Name
Applicants Address
Phone Number
Gender
With which category/categories do you identify? Select all that apply.
Primary Language Spoken
Current Living Situation
Medical History (check all that apply)
If you have had multiple strokes, list the date of your most recent.
Which side of your body was affected by your stroke?
Do you have impaired gait/walking ability because of your stroke?
Do you have impaired arm/hand function because of your stroke?
Do you have impaired swallowing or speech function because of your stroke?
Did you have a traumatic brain injury or nontraumatic brain injury?
Was your brain injury an open or closed injury?
Did your injury result in paraplegia?
Is your paraplegia complete or incomplete?
Did your injury result in quadriplegia?
Is your quadriplegia complete or incomplete?
What was the level of your injury?
Have you been diagnosed with Alzheimer’s Disease?
Have you been diagnosed with Parkinson’s Disease?
Have you been diagnosed with Multiple Sclerosis?
Have you been diagnosed with Cerebral Palsy?
Have you been diagnosed with a neurodegenerative condition not listed above?
Please select the best description for your amputation:
Please indicate which assistive device(s) you use. Check all that apply.