Database Consent Form

I, , of

agree to participate as a subject in the study described in the Participant Information Sheet set out above.

1. I acknowledge that I have read the Participant Information Sheet, which explains why I have been selected, the aims of the study and the nature and the possible risks of the investigation with regards to data storage and privacy with the database, and the database has been explained to me to my satisfaction.
2. Before signing this consent form, I have been given the opportunity of asking any questions relating to any possible harm I might suffer due to a data or privacy breach of the database as a result of my participation and I have received satisfactory answers.
3. I understand that I may be able to have my research data deleted and this will not prejudice my relationship to the investigators or Royal North Shore Hospital.
4. I agree that research data gathered from the results of the study may be published, provided that I cannot be identified.
5. I understand that if I have any questions relating to my participation in this research, I may contact RNSH Endocrine Database manager (Ph: +61 2 9463 1473) who will be happy to answer them.
6. I acknowledge receipt of a copy of this Consent Form and the Participant Information Sheet.

Complaints may be directed to the Research Office on Level 13, Kolling Building, Royal North Shore Hospital, St Leonards NSW 2065
Phone 02 9926 4590 | email NSLHD-research@health.nsw.gov.au

The custodians charged with ensuring appropriate standards are met in storing and managing the RNSH Endocrine Database will have access to your data. Researchers involved in research approved by a Human Research Ethics Committee may also have access to your data. Access to your data for research will be controlled by the RNSH Endocrine Database manager.