Doctor's Update 2 - Control Research Volunteer Form: Relative/spouse/friend of the person with PD

PD Research Introduction | Dr. Gosal's Article | Volunteer Information/Instructions | Patient Volunteer Form

Please note: You will only be contacted for the purposes of this research. Your name will not be added to any database other than this one, and your contact will either be Dr. Gosal or another member of Dr. Lynch's team.

"YES, I'D LIKE TO PARTICIPATE IN YOUR RESEARCH!
This form - the YELLOW FORM - is for the relative/spouse/friend/partner of the person with PD to complete - for the CONTROL GROUP.

IF YOU ARE VOLUNTEERING A BLOOD SAMPLE FOR THE CONTROL GROUP, PLEASE FILL IN YOUR DETAILS ON THIS PAGE.
If you are volunteering for the PD group (i.e. you have PD), please click HERE to go to the GREEN form.
Any information you supply will be treated as confidential, and will be used only to contact you to arrange to collect a blood sample.
I am a spouse/partner/relation/carer/friend of a person with PD, and I would like to help by providing a blood sample for the Control Group. I understand that the results of the analysis of my blood sample can not be divulged to me.

Your name
Spouse/partner/relation/carer/friend? (Please specify)

Phone number (daytime)

Your email address

Please write your postal address here:
Address:

Do you have any relatives who have Parkinson's disease? Please type Yes or No!
If Yes, please list:

If there is anything else you feel might be relevant to add, please do so in this text box: Additional information:

-Click on "SUBMIT" to send this form to Dr. Gosal. Someone from the team will then contact you to arrange to obtain a blood sample. Our thanks go to you.