ROAM @ Moorfields

Before You Continue

Please be aware that by providing your information, you are expressing interest in future research opportunities. We will only review your details when a suitable opportunity becomes available. You won’t hear from us immediately, but when a relevant research study comes up, we will contact you. Your information will be handled securely and in line with our privacy policy.

Please specify reason for getting involved:

I have an eye condition I am a parent or guardian I am a healthy volunteer

Parent and guardian advise

Thank you for considering to have your child participate in Research opportunities at Moorfields. Please ensure that you read and answer each section carefully on behalf of your child before submitting.

and you would like to participate in...

Participation in Research at Moorfields

Participation means a patient or member of the public has given informed consent to join a research study. This involves reviewing information materials and signing a consent form approved by the ethics committee

Examples of participation include:

Providing a blood sample or tissue biopsy
Completing a quality of life or mental health questionnaire.
Trialing a new procedure or medical intervention
Sharing personal experiences in interviews

Public Involvement (PPI) refers to research conducted with the public, not just about them. PPI recognizes the valuable insights that individuals with personal experience bring to the research process.

Examples of involvement include:

Serving as a co-applicant on a research project
Contributing to study design and patient information materials
Advising on study management
Assisting with data collection and analysis
Participating in writing and sharing research findings

Engagement is about sharing research information and fostering two-way dialogues between researchers and the public.

Examples of engagement include

Participating in public science festivals with discussions and debates
Hosting open days for the public to learn about research
Raising awareness through media platforms like TV, newspapers, and social media
Sharing research findings with participants and the wider community

clinical research studies patient, public involvement and engagement both

Are you or have you been a Moorfields patient?

Yes No

Why we ask for your hospital number?

If you are a patient of Moorfields Eye Hospital and would like to participate in our research, please provide your hospital number and a member of our research team will only review it when suitable research studies come up for which you may be eligible. Once a relevant study becomes available, we will contact you to discuss potential participation.

Please enter your hospital number

Required

Why do we ask for this?

Your hospital number can be found in the top right corner of the correspondence sent for your hospital visit.

Not registered at Moorfields?

If you are not a patient at Moorfields Eye Hospital but wish to participate in our research, we will collect your information and only review it when suitable research studies come up for which you may be eligible.

You do not need to take any immediate action. Once a relevant study becomes available, we will contact you to discuss potential participation.

Please enter your NHS number

Required

Why do we ask for this?

Your NHS number is a unique 10-digit code, such as 485 777 3456. It ensures healthcare providers can accurately identify you and match your details to your health records.

First Name

Required

Last Name

Required

Date of Birth

Required

Why do we ask for this?

We use your date of birth to match you with research studies suitable for your age. Some studies require specific age groups, and you must be 18 or older to register.

What is your preferred contact method?

Email Phone

Required

Why do we ask for this?

To register you will need to provide a valid email address. This is so that we can send you a confirmation email once you have registered.

Contact number

We would like to collect some additional information?

To help us understand a little more about you, we would like to collect your ethnicity, ethnicity and medical condition. This will help us clearly identify suitable research opportunities at Moorfields and/or patient, public involvement and engagement that are appropriate for you.

Sex at birth

Male Female Intersex

Why do we ask for this?

We ask for your biological sex at birth because for some research we need to screen for sex-specific conditions and treatments.

Gender

Woman Man Non-binary Gender fluid Other term Prefer not to say

Why do we ask for this?

Understanding the gender of participants helps us to analyse and report on the diversity of those taking part in research. This information ensures our studies are inclusive and representative of different communities. If you prefer not to share this information, there is an option to select "Prefer not to say."

Ethnicity

Asian or Asian British Black, Black British, Caribbean or African Mixed or multiple ethnic groups White Other ethnic group

Why do we ask for this?

Some eye conditions affect certain ethnic groups differently, and understanding these variations helps researchers develop targeted treatments and improve health outcomes for all.

Based on your ethnicity selection, please choose from the following options

Indian Pakistani Bangladeshi Chinese Any other Asian background

Caribbean African Any other Black, African or Caribbean background

White and Black Caribbean White and Black African White and Asian Any other Mixed or Multiple ethnic background

English, Welsh, Scottish, Northern Irish or British Irish Gypsy or Irish Traveller Gypsy or Irish Traveller Any other White background

Arab Any other ethnic group

From the options below, can you tell us about your eye condition and if you have one or more?

Cornea or Surface of Eye Eyelids or Orbit Cataract Diabetic Retinopathy Glaucoma Macular Degeneration Neuro-Ophthalmology Inherited Eye Disease Other Retinal Disease Retinal Conditions (surgical) Eye Tumours and Allied Conditions Paediatrics Prosthetics Uveitis Other or Not Sure

Why do we ask for this?

We ask for your main condition(s) to help match you with relevant research opportunities and allow study teams to focus on reviewing participants who may be eligible. You can find this information in a recent hospital letter or by checking your medical records through the NHS App.

Based on your selections, can you tell us further information about your condition(s) from the options below?

Keratoconus Corneal Dystrophy Blepharitis Dry Eye Other or Not Sure

Blepharospasm Thyroid Eye Disease Tear Ducts Other or Not Sure

Normal Tension Glaucoma Narrow Drainage Angles or Angle Closure Primary Open Angle Glaucoma Other or Not Sure

Wet AMD Dry AMD Other or Not Sure

Retinal Vein Occlusion Other or Not Sure

Retinal Detachment Epiretinal Membrane Other or Not Sure

Naevi (moles) Melanoma Retinoblastoma Other tumours within the eye Other tumours on the surface of the eye Other conditions related to eye tumours

Thank you for signing up, please read and let us now that you are happy for us to stay in touch with you:

I consent for Moorfields Eye Hospital NHS Foundation Trust to use the data I have submitted to contact me about research opportunities which may be suitable for me. We process and analyse your data, including whether you have an eye condition or not, so that we can send you information that is relevant to you. We will never share your details with anyone not directly working on our behalf. For more information, read our Privacy Policy.