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Letter Self-Referral

Self-Screening Questionnaire

LETTER SELF-REFERRAL

Please answer the questions below if you would like to speak to a member of the research team about taking part in the study. Your answers will be sent to the University of Leeds Clinical Trials Research Unit (CTRU) D-MAPP coordinating team who will pass your details to the research team in your local area (if there is one), or to the research team at either Leeds Teaching Hospitals or Leeds Community Healthcare. Your details will be stored at the CTRU until the research team have been able to speak with you. If you decide not to take part, your information will be deleted.

/// PATIENT INFORMATION SHEET PDF WILL SHOW HERE ///

Self-Referral Questionnaire

1. Have you read and understood the participant information sheet?

2. Do you still have your upper limb/hand condition?

3. How would you rate the pain caused by your condition?

4. Are you happy to provide your contact details for the research team?

5. Are you happy for the research team to contact you in relation to this study?