TEST form

Please describe the details of your role as a carer to someone with dementia and agitation

Do you identify as Aboriginal or Torres Strait Islander?

Yes, Aboriginal

Yes, Torres Strait Islander

Prefer not to say

Have you completed any of the following?

High school certificate

Trade certificate

Undergraduate degree (Bachelor or lower)

Postgraduate degree (Masters or higher)

Current or past occupation / area of study / other

Experience of clinical trials

I have participated in a clinical trial

I participated in screening for a clinical trial, but was found not to be eligible for the trial

I am currently participating in a clinical trial

I have cared for/am the parent of someone who has participated in/is participating in a clinical trial

I have not participated in a clinical trial

Other

Please tick all that apply

I have an interest in partnering in research and presenting a consumer/patient/carer perspective to discussions

I am willing to participate in discussions in an open, respectful and constructive manner

I am available for a face-to-face meeting on 31 October 2023 from 12-4pm

Have you any specific support needs? - optional

Would you like to register?

Yes

Please tick this box if you do not wish to be contacted about future activities conducted by UniSC Clinical Trials.

TEST form | UniSC | University of the Sunshine Coast, Queensland, Australia