Consent Form TASMAN-study

Dear participant,

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Here you find a digital version of the Information Letter for Patients regarding the TASMAN-study.

If you have read the information letter carefully and want to participate in this study, please sign the declaration of consent below.

Attachment:Patient Participant Information Form PICF TASMAN-study version 3 clean-geconverteerd(1).pdf

Declaration of consent

For participation in the clinical study:

TASMAN-study, a medical scientific study on patients with movement disorders

By ticking the box 'I agree' below I give my permission for participation in the aforementioned medical scientific research.

- I have read or had read to me in a language that I understand the Participant Information sheet and this e-consent form, and I understand the purposes, procedures and risks of this research project as described within it.

- I understand the purposes, procedures and risks of the data collection described in this document.

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

- I acknowledge that my involvement may not be of benefit to me.

- I understand that I can withdraw my consent to participate in this research project at any time without stating a reason

- I freely agree to participate in this research project as described.

- I consent to storage of my data for a period of a maximum of 15 years after closure of the study.

* must provide value

I agree I disagree

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Verification question 1:
Where do you have an appointment with your neurologist soon?

* must provide value

Princess Alexandra Hospital, Brisbane

Brisbane Clinical Neurosciences Center

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Verification question 2:
Which date is your appointment at ______ scheduled?

* must provide value

D-M-Y

Verification question 3:
What time is your appointment at ______ scheduled?
(e.g., 09:30)

* must provide value

H:M

Thank you for your consent!

If you click 'submit', you can directly complete the online questionnare.

Since you disagree to participate in the study, you can not complete the questionnaire.

If you click 'submit', this consent form will be closed.

Mark field as:

[Clear value]

Unknown (UNK)

Not applicable (NA)

Invalid (INV)

You have selected an option that triggers this survey to end right now.

To save your responses and end the survey, click the 'End Survey' button below. If you have selected the wrong option by accident and/or wish to return to the survey, click the 'Return and Edit Response' button.