Research Consent

1. Please review the information carefully before providing consent. This form is only required once.

2. If you choose to participate, a copy of this consent form will be sent to the email address you have provided.

Participant Information

First Name

Please enter your first name.

Last Name

Please enter your last name.

Date of Birth

Please enter a valid date of birth. You must be at least 18 years old to participate.

You must be at least 18 years old to participate.

Email Address

Full PDF of Official Research Information Sheet available for download

Printed name:

Printed date of birth:

Printed date and time of consent:

I AGREE TO PARTICIPATE IN THIS RESEARCH

I DO NOT AGREE TO PARTICIPATE