Emergency Department

202 S. Park St.
Madison, WI 53715

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Supplemental Forms for Researchers

Download and complete the following forms to submit with your online application.

Record Review Research Forms

Interventional Research Forms

Collaboration Endorsement Letter Template
Use this to document how UnityPoint Health – Meriter staff will help facilitate your research on our premises. The letter should be signed by a department or work area manager, director or other authority.

Permission to Contact Form (HIPAA Compliant)

Consent Template 

Consent Checklist 

Formatting to Accommodate IRB Approval Stamp

HIPAA Authorization Form

Meriter Site Supplement

Website Listing FormComplete this form if your research has a consent document. This form is not required for record review or biospecimen research.