Carer/Relative Sign Up

Before completing the online form below, please download and read the following information leaflet:

Rowling CARE Patient Information Leaflet (Carer/Relative) v1.0 23rd Nov 2021

Please see our privacy statement for more details of how we use the information we collect about you.

    1) I confirm that I have read and understood the information sheet (dated 23rd November 2021, version 1.0) for the above study. I have had the opportunity to consider the information and ask questions. (Required)

    2) I agree to the storage of my data in the way described in the information sheet for the purposes described. (Required)

    3) I give permission for my personal information (including name, address, date of birth, telephone number, email address and consent form) to be passed to the University of Edinburgh for administration of the study. (Required)

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


    Confirmation research purposes

    5) I agree to be contacted if there are research opportunities involving carers/relatives. (Required)

    Confirmation research studies contact

    6) I agree to be contacted to assist in the design of research studies and their documentation. (Required)

    Confirmation research future design

    7) I agree to be contacted if there is a need for members of a focus/consultation group or advisory group for the Anne Rowling Clinic or associated research project. (Required)

    Age Group (Required, so that we can tailor the information we send)

    Age Group

    Diagnosis of the person you care for (Required)

    Diagnosis of the person you care for

    Further MS Diagnosis

    Further MS Diagnosis

    Don’t have an email address? No problem, you can still sign up to Rowling CARE. Please speak to a member of staff or call us on 0131 465 9517.

    I prefer to be contacted by:

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