I give my consent for this information about MYSELF OR MY CHILD OR WARD/MY RELATIVE relating to the subject matter above (“the Information”) to appear in a journal article, or to be used for the purpose of a thesis or presentation.
I understand the following:
The information will be published without my name/child’s name/relatives name attached and every attempt will be made to ensure anonymity. I understand, however, that complete anonymity cannot be guaranteed. It is possible that somebody somewhere - perhaps, for example, somebody who looked after me/my child/relative, if I was in hospital, or a relative - may identify me.
The information may be published in a journal which is read worldwide or an online journal. Journals are aimed mainly at health care professionals but may be seen by many non-doctors, including journalists. The Information may be placed on a website.
I can withdraw my consent at any time before online publication, but once the information has been committed to publication it will not be possible to withdraw the consent.