Request a user account

Please fill the form below to request access to OKINADA. All fields marked with an asterisk (*) are required.

*First Name:
*Last Name:
*Email Address:
*Phone Number:
Site (if known):
Your Role at the Site: Principal Investigator
Sub- or Co-Investigator
Study Nurse or Coordinator
Image uploading only
*Requested Username:
*Re-enter Password:
*Security Question: