Participation Forms

When you register to participate in the Western Connecticut Health Network Lyme Disease Registry a research assistant will review the following document with you. They will also answer any questions you may have.

Your Personal Health Information is Important to Us

We take patient privacy very seriously and want you to feel confident about your participation with the Lyme Disease Registry.

All information provided to the Lyme Disease Registry, including laboratory results and medical history, are coded using labels with a unique identification number. Only the investigator and designated site staff will have the key to link an identification number to the corresponding participant. The results of any analyses that are run are not linked to any given person, and all research information is kept strictly confidential.The latest HIPAA Privacy Rule regulations are followed.

For More Information

You’re invited to register to participate in the Western Connecticut Health Network Lyme Disease Registry. You can learn more about the Lyme Disease Registry online or please contact the Lyme Disease Registry for more information or if you have questions.

Search our Find a Doctor online tool to find a doctor near you. If you need a doctor referral, call us at 1-800-516-3658.