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Protect Your Pearls Registration

Two simple steps to register - STEP 1

Please fill in the following information if you would like join the project. All personal details will be kept strictly confidential
* Required field

First Name*

(same with HKID)

Last Name*

(same with HKID)

Gender*

Day of Birth*

Month of Birth*

Year of Birth*

Do you have any sexual experience?*

Have you ever had any cervical screening in the last 3 years?*

Are you undergoing treatment for CIN or cervical cancer?*

Have you ever received HVP vaccine?*

Are you pregnant?*

Did you have a hysterectomy?*

I understand that this program is part of a clinical study and enrollment is only for participants who agree to the terms and conditions on the clinical study consent form presented at the clinic on the day of appointment. *

I confirm, that I have read and understood the information sheet for the project for a better overall grasp on how to protect myself against cervical cancer. *

I understand that my participation is voluntary and that I am free to withdraw at any time, without giving any reason, without my medical care or legal rights being affected. *

I agree to take part in the above cervical screening programme. *

I here with acknowledge that, if I am currently experiencing irregular bleeding, spotting or pain during my menses, sex or randomly, I cannot join the project. We kindly encourage you to contact your GP immediately and seek a professional opinion. . *

I have read and agree to the Terms and Conditions. *

Sorry, based on your answers you do not meet the project requirement

Protect Your Pearls Registration

Two simple steps to register - STEP 2

* Required field

How would you like to be contacted for the program?*

SMS

Contact Details

Phone Number*

Only valid HK phone numbers are accepted

Email Address*

Region*

District*

Address*

Let us know more about you*

How have you heard about this study?

Address

25/F, LHT Tower, 31 Queen’s Road Central, Hong Kong.

Email

info@karenleungfoundation.org

Phone

+852 2847 7632

Protect Your Pearls Registration

Protect Your Pearls Registration

Newsletter

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Please Fill in all the required fields.