Cochrane Consumer Network Application | Cochrane Consumer Network

Thank you for your interest in the Cochrane Consumer Network.

Please complete this short form to get involved:

If you have any difficulty completing this form, please email ccnet@cochrane.org for assistance.

Are you already involved with CCNet?

Contact Information

Prefix

First name

Family name

Organisation or affiliation

Address

City

State/Province

ZIP/Postal code

Country

Communications

E-mail address

Please verify your e-mail address

Daytime phone number

(include international dialing code, e.g., +44)

Skype name

Preferred contact method

Consumer and Patient Interests

What is the primary reason that you search for healthcare information? Choose one

Patient perspective for personal use

Professional, working in a health-related field

Professional, working outside of the health field

Which role best describes how you use healthcare information?

If medical professional, what is your current area of work?

If other, please specify

If you do not work in the healthcare field, please indicate your current area of work:

Please list the areas of health care that interest you

Name any related organizations with which you are associated

Are you associated with any Cochrane groups? Please specify

Confidentiality

Any personal information collection is kept strictly under Privacy Regulations and is used solely for consumer participation activities of The Cochrane Collaboration.