penn surgery
penn surgery home clinical home education home research home administration home
 
 
trauma division home page
 
Injury Research Saves Lives
Research
Traumatology, Surgical Critical Care and Emergency Surgery
 
AVERT Opt Out Bracelet and Registration Form
 
First Name
M.I.
Last Name
 
Mailing Address
 
City
State
Zip Code
 
Email Address
 
Date of Birth
Month
Date
Year
 
You will receive your Opt Out bracelet, which will read "No AVERT Shock", in 5-10 business days. You must wear your bracelet at all times so that if you are seriously impaired we will know you do not want to participate in this study. This study is expected to last up to 3 years. Thank You!

 

footer Terms of Use Legal Disclaimer Site Map Contact Us Financial Assistance About Penn Medicine Privacy Statement

penn medicine