This system is intended only for specific individuals who have been granted access by the Clinical Trials Coordination Center. If you are not the intended user, or the person responsible for submission on behalf of the intended user, you are hereby notified that any dissemination, distribution, copying or use is strictly prohibited.

To obtain your CTCC Unique ID please complete all of the fields below. Your answers should be the common way you would answer each of the questions in case you return here in the future. We do not retain any of this information once we generate your identification number. The Unique ID number is for use in clinical studies being conducted by the Clinical Trials Coordination Center at the Univeristy of Rochester. If you ever forget your number you can return to this website to find your ID number. If you have any questions about this system please contact the Clinical Trials Coordination Center.

First Name (at birth):

Last Name (at birth):

Gender (at birth):

Day of Birth:

Month of Birth:

Year of Birth (YYYY):

City of Birth:

Country of Birth:

Mother's Maiden Name (if unknown, enter your own last name at birth):

Copyright 2005 Clinical Trials Coordination Center Last Update: March 15, 2005 Designed by: James Avery