Sign up for T1D Risk Screening

Please answer a few questions below to see if you qualify for TrialNet Pathway to Prevention risk screening.

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Up
Select
Preference
Provide
Consent
Get
Screened!

1. What country do you live in?*

2. Who will be screened for type 1 diabiates risk?*

I’m signing up for myself.

I’m signing up for my minor child/children.

I’m signing up for my myself and my minor child/children.

3.Please tell us about yourself:

First Name:*

Last Name:*

Email Address:*

Phone:*

Date of Birth:*

ZIP/Postal Code:*

4. Please answer the following questions:

Have you ever been diagnosed with type 1 diabetes?*

YES

Do you have a relative with type 1 diabetes?*

YES

Has your minor child/children ever been diagnosed with T1D?*

YES

Is your minor child/children at least one year or older?*

YES

How many family members will be screened?*

I’d like to receive news and updates from TrialNet about important T1D research.

*Required Fields

Based on your answers, you qualify for T1D risk screening. With flexible options for your convenience, getting screened is easy!

Sign
Up
Select
Preference
Provide
Consent
Get
Screened!

How would you prefer to get screened?

I'd like to receive a screening kit in the mail.

Select this option to receive a home screening kit in the mail. Simply complete your blood draw in the convenience of your own home by using a provided finger stick, then mail it back to TrialNet in a pre-paid envelope, all at no cost to you. Getting screened has never been easier.

Select This Option

I'd like to make an appointment at a TrialNet location.

Select this option if you prefer to schedule an in-person appointment and visit a TrialNet location to complete your screening. With more than 200 TrialNet locations, TrialNet has you covered!

There are 5 locations based on your ZIP (98272). Please select one:

Benaroya Research Institute at Virginia Mason 1204 9th Avenue, Seattle, WA 98101

33mi

Seattle Children’s Hospital & Regional Medical Center 4800 San Point Way NE, Seattle, WA 98105

33mi

Wenatchee Valley Medical Center 820 N Chelan Ave, Wenatchee, WA 98801

107mi

Randall Children’s Hospital at Legacy Emanuel 2801 N Gantenbein Ave, Portland, OR 97227

206mi

Oregon Health & Science University 3181 SW Jackson Park Rd, Portland, OR 97239

207mi

Select This Option

I’ll take a screening kit to a Quest Diagnostics near me.

For those not in the area of a TrialNet location and not interested in a home screening kit, screening opportunities are also offered at Quest Diagnostics throughout the US. By selecting this option, you will be required to find a Quest location near you in order to complete your screening.

Select This Option

Screening participants must provide consent for TrialNet’s permission to analyze your blood sample and contact you with the test results.

Sign
Up
Select
Preference
Provide
Consent
Get
Screened!

Your Informed Consent:

Participant Information*

Have you ever been diagnosed with type 1 diabetes?*

YES

Are you the parent of legal guardian of this family member?*

YES

First Name:

Last Name:

Date of Birth:*

Family History*

Relationship:

Age of relative when diagnosed with T1D:

Participant Details

Gender:

Ethnicity:

Race:

Prefer not to say

American Indian/Native

Alaskan

African-American/Black

Asian

Pacific Islander/Native

Hawaiian

White (Caucasian)

Enter Shipping Address *

Address:

Apartment, Suite, Building (optional):

City:

State:

ZIP/Postal Code:

Country or Region:

Review the Informed Consent*

Please review the terms of consent outlined below, then answer a few questions to continue. By accepting this consent you agree that TrialNet has your permission to send you a T1D screening kit, analyze your blood sample, and contact you with the test results.

Terms of consent Print

FPO

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I have read and agree to the terms of consent. I understand that by completing this form, I am consenting to be screened for the TrialNet Pathway to Prevention Study. I understand that I will be responsible for next steps to complete my blood draw based on my selected screening preference. Blood samples will be collected and submitted to TrialNet for analysis to determine risk for developing type 1 diabetes (T1D).

*Required Fields

Have Questions? We can help.

Get in touch with TrialNet! Mon-Fri, 8am to 5pm ET

Ask Us! Call (800) 425-8361