Join the Australian Schizophrenia Research Bank

Help find a cure for schizophrenia

• Use the on-line enrolment form below
• Contact the Australian Schizophrenia Research Bank on freecall 1800 639 295 or email on asrb@schizophreniaresearch.org.au

Once you have enrolled, you will be contacted by a representative from the Australian Schizophrenia Research Bank. The requirements of the program will then be discussed in detail and you will have the opportunity to ask any questions you might have.

Important Information Regarding Eligibility

Please note that the Australian Schizophrenia Research Bank has geographic and demographic limitations.

• This program can only recruit volunteers from NSW, ACT, VIC, WA and QLD. In general we can only enrol people from capital/major cities in these states/territories and major centres outside the capital cities where there are clusters of volunteers.
• This program is only recruiting people with schizophrenia, schizoaffective disorder or healthy controls (with no personal or family history of mental illness).

On-Line Enrolment Form

I would like to enrol in:	Australian Schizophrenia Research Bank (NSW, ACT, QLD, WA, VIC only)
Family name:
First name:
Date of Birth:
Address:
State:
Postcode:
Email Address:
Telephone home:
Telephone work:
Telephone mobile:
Classification:	diagnosed with schizophrenia / schizoaffective disorder no history of schizophrenia
Do you have any family members with schizophrenia?	Yes No if yes, how many?
What gender are you?	Male Female
How did you hear about these programs?	tv advertisement, (station? ) radio advertisement, (station? ) internet press (e.g. newspaper) doctor / case worker family / friend other
Preferred method of contact	email work phone home phone mobile phone post
Contact Person We will try to keep in contact with you but in case we lose touch, please supply a name and contact address of a close relative or friend
Name
Address:
Postcode:
Telephone Home:
Telephone Work:
Keep Informed The Schizophrenia Research Institute publishes a free quarterly newsletter.
Would you like to be added to the mailing list?	Yes No

 

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