Barts and Queen Mary Science Festival 2023

As the contribution of TrialsConnect to the Science Festival 2023 we are providing an adapted version of the medical history form that was used to train volunteer medical students screening patients joining the COVID vaccine trial at Bethnal Green Library in 2019/20. This clinical trial was managed by Queen Mary University of London and Barts NHS Health Trust.


Try asking an older adult family member, family friend or  neighbour if they are willing to be your sample ‘patient’. You must be sure to ask their permission and make it clear that they do not have to answer any question they do not want to. Only use a first name or a made-up name so that they cannot be easily identified.


Once you have permission you become the screening doctor for a clinical trial…

Download the form here.

If you are a student studying GCSE science or a sixth form / college student studying A Levels or equivalent then you can submit your completed form to us by 14 July 2023 for certificate and/award judging. Details are are on the final page of the form.


You will need to use Adobe Acrobat to complete the form on screen. The saved file can then be e-mailed. Alternatively print the form from any pdf reader software and then scan or photograph it tor e-mail .