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Researchers Inviting Adults Who Are Looking To Quit Using Cocaine or Crack

Consent to Continue

After completing this brief questionnaire, more detailed information will be provided to you before you decide whether or not to take part in the research, and you will have the opportunity to speak with and ask questions to a study coordinator. You can stop this discussion at any time.
Please note that by completing this questionnaire, you consent to us collecting your answers to the questions, including your contact information.  All information you provide in this questionnaire will be held in strict confidence, and shared only with the research center conducting the study. Vital Research will delete your information from our records upon your request. While completing the questionnaire you will have the option to join our mailing list to be contacted via email about future clinical trials for which you may be eligible. You will not be contacted about future trials if you choose not to sign up to our mailing list.

For your reference, please find a link to the Vital Research Privacy Policy.

Please note:
Due to the current situation with COVID-19 pandemic, the study team would like to point out the following:
  • The research site does not treat COVID-19 patients and/or suspected COVID-19 patients.
  • The research site’s waiting area is spacious enough that participants will not be within close proximity to each other.
  • Hand sanitisers are available at the research site.
  • The research staff adheres to strict hygienic practices as well as other safety measures to prevent the spread of COVID-19.
  • Any staff suspected to have COVID-19, or has come into contact with someone who has COVID-19, will automatically undergo a voluntary quarantine for 14 days.
  • Interested participants will not be left waiting for a long period of time and will be quickly attended to.
  • Parking is available at the research site.
  • The study team encourages the use of personal vehicles, taxi or rideshare services rather than public transit.
  • The research site/institution is taking all precautionary measures to ensure the safety of the study participants.

Are you willing to continue? *This question is required.