Patient Sign Up | Rowling-CARE

I confirm that I live in Scotland, and have a neurological condition.

I confirm that I live in Scotland, and have a neurological condition. (Required)

Confirmed reading/understanding of information sheet

I confirm that I have read and understood the information sheet (dated 12th August 2019, version 3.1) for the above study. I have had the opportunity to consider the information and ask questions. (Required)

Confirmed voluntary participation

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. (Required)

Agreed to data/medical notes for research purposes

I understand that relevant sections of my medical notes and data collected during the study may be looked at by the research team, and individuals from the Sponsor (University of Edinburgh), NHS Lothian, or regulatory/other authorities, where it is relevant to my taking part in this research. I give permission for these individuals to have access to my records. (Required)

Opt in for non-identifiable data for research usage

I agree to the use of my non-identifiable data for research (this means that we can use your data for research, but only with your name, date of birth and address removed).

I agree to the sharing of my non-identifiable data with other researchers for research purposes (this means that we can share your data with our research collaborators and partners, but only with your name, date of birth and address removed).

Opt in to storage of contact details/future contact for other studies

I agree to the storage of my contact details and re-contact in the future regarding other research studies that may be of interest to me.

Opt in for contact in design/implementation of future projects

I agree to be contacted to assist in the design and implementation of future research projects.

Agreed to be contacted for focus/consultation group

I agree to be contacted if there is a need for members of a focus/consultation group

Diagnosis (Required)

I don't have a diagnosisI don't know what my diagnosis isMultiple sclerosis (MS)Motor neurone disease ( MND / ALS )Parkinson's disease (PD)Dementia (any type)Other

Further MS Diagnosis

relapsing remitting (RRMS)primary progressive (PPMS)secondary progressive (SPMS)Other/I don't know