top of page

Please ONLY complete this form if you DO NOT want to participate in the Registry

This form is only to be completed if you do not want your information to be collected for the Registry.

Declaration by Participant

  1. I do not wish to participate in the Registry and I understand that my decision will not affect my future health care.

  2. I have read the attached Participant Information Sheet. 

  3. I understand the purposes, procedures and risks of the research described in the project.

  4. I have had an opportunity to ask questions and I am satisfied with the answers I have received.

​

Please complete the following information so your preferences are successfully recorded

Please complete the following information so your preferences are successfully recorded:

Thanks for submitting!

bottom of page