Enter staff email if no participant email available
Enter 000-000-0000 if no cell number available
Required only if no cell number available
Name for Registration (Not required if File Number exists)
File Number (If applicable)
Reason for Contact
Registration for a New Account
Existing Account Troubleshooting
Other: will describe during appointment
Preferred Times and Dates for being contacted (Optional)
Please indicate the best time and day of the week to be contacted. Note that we will try our best to accommodate your preferences.
Agrees to being contacted by phone by the GetaKit team.
Registration for an account should take approximately 30 minutes. The Consent Forms for participating will be reviewed for you to decide if you want to continue with registration.
Troubleshooting for a participant with an existing account will take approximately 15 minutes.
Please email us if there are changes at
Note that Personal Health Information should not be shared via email, and should instead be shared during the telephone call.