The attitudes of patients with ataxia to clinical trials - UK survey

1. Consent form

IRAS ID: 260860

REC Ref: 19/LO/0764

Question Title

* 1. I confirm that I have read the information sheet dated 22/03/2019 (version 1) for the above study. I have had the opportunity to consider the information, ask questions and have had these answered satisfactorily.

I understand that my participation is voluntary and that I am free to withdraw at any time without giving any reason, without my medical care or legal rights being affected.

I understand that the information collected about me will be used to support other research in the future, and may be shared anonymously with other researchers.

I agree to take part in the above study.

By ticking "Yes" you agree to the above conditions and will proceed to the survey.
Ticking "No" will terminate the session.

Yes

If you have any questions about the research study, please contact either:

Julie Greenfield.
Email: jgreenfield@ataxia.org.uk
Telephone: 020 7582 1444
Address: Ataxia UK. 12 Broadbent Close, London, N6 5JW.

or:

Dr Gilbert Thomas-Black
Telephone: 020 3448 3100
Email: g.thomas-black@ucl.ac.uk
Address: The National Hospital for Neurology and Neurosurgery
Department of Clinical and Movement Neurosciences
Queen Square, London
WC1N 3BG