Cancer Clinical Trial Registration & Patient Matching

Connect your diagnosis with investigational oncology protocols, novel checkpoint inhibitors, biomarker trials, and precision oncology therapies.

Trial / Study Identification (If Known)

Institution / Cancer Center

Trial Name or NCT Code

Principal Investigator

1. Participant Information

Full Legal Name *

Date of Birth

Gender

M F Other N/A

Phone Number *

Email Address *

Street Address

City / State

Preferred Language

Emergency Contact

Relationship

Emergency Phone

2. Medical & Cancer Clinical Details

Primary Cancer Diagnosis *

Date of Diagnosis

Current Stage

Prior Therapies Received

Surgery Chemotherapy Radiation Immunotherapy Other Treatments

Current Medications

Allergies

Other Health Conditions (Comorbidities)

3. Preliminary Trial Screening Questions

Participated in a trial before?

Yes No

Currently pregnant / nursing?

Yes No / N/A

Willing for diagnostic tests?

Yes No

4. Consent & Electronic Signature

I confirm that the medical information provided is accurate to the best of my knowledge. * I authorize ONCORG clinical coordinators to screen this information against active trial protocols. * I understand that clinical trial participation is completely voluntary and subject to principal investigator approval. *

Participant Signature (Type Full Name) *

Signature Date

Witness / Caregiver Name (Optional)

Witness Signature

Witness Date

Search Active Trials (ClinicalTrials.gov) → Second Opinion Assistance Financial Guidance