Project Title: "Recognizing left from right arms by individuals with stroke"

Principal Researcher: Leeanne Carey
Associate Researcher(s): Brendon Haslam, David Butler and Halton Stewart
Institutions: Florey Institute of Neuroscience and Mental Health, University of Melbourne in collaboration with LaTrobe University and Neuro Orthopaedic Institute

Consent to use of submitted information for research:

In giving my consent I acknowledge that:

  1. The procedures required for the project and the time involved (including any inconvenience, risk, discomfort or side effect, and of their implications) have been explained to me, and any questions I have about the project have been answered to my satisfaction.
  2. I have read the Participant Information Statement (step 1: the project) and have been given the opportunity to discuss the information and my involvement in the project with the researcher/s.
  3. I understand that I can withdraw from the study at any time, without affecting my relationship with the researcher(s), therapy practices or The University of Melbourne now or in the future.
  4. I understand that my involvement is strictly confidential and no information about me will be used in any way that reveals my identity.
  5. I understand that being in this study is completely voluntary. I am not under any obligation to consent.
  6. I consent to receiving feedback via the available online report.

Thank you for agreeing to participate in this study, your participation is greatly valued.

I consent to use of my results for the purpose of this research
I consent to use of my results for the purpose of possible future research
I have read and I understand the Terms and Conditions of the website

*You should print and keep a copy of this form