Yes	No
I agree to take part in this research project.
I have read the Information Sheet provided which explained the procedures involved and of what is expected of me.
Prior to my survey being submitted, I understand that I may withdraw from participating in the project without prejudice.
I understand that all information provided by me is treated as confidential and will not be released by the researcher to a third party unless required to do so by law.
I agree that any research data gathered for the study may be published provided my name or other identifying information is not disclosed.
I understand that research data gathered may be used for future research but my name and other identifying information will be removed.
I understand that a MRI scan will be performed to confirm my diagnosis (if I do not already have one) and that the report for this MRI will be accessible to the research team.
Please sign below to confirm your responses to the previous questions. Date: