Self-Screening Questionnaire
NON-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.
D-MAPP_PatientInformationSheetAndConsentForm_v2.0_IRAS-330550_15.11.24_clean
Download Patient Information Sheet
Self-Referral Questionnaire
The information you enter here is not stored in any form. The form scores points based on internal criteria in order to determine your potential elgibility for the D-MAPP clinical trial. If the score determines that you are potentially eligible, you will be directed to a contact form where you can send your details to the D-MAPP trial team.
The University of Leeds is responsible for what data is collected, what it is used for and making sure it is used correctly and legally (this means they are called the ‘data controller’). You can ask to see the information we have about you, or have it corrected or deleted. You can also ask for us to stop using your information or only use it in specific ways that you allow. If you would like to do any of these things, please contact the research team on: foxtrot@leeds.ac.uk
For more about how data is used at the Leeds Institute of Clinical Trials Research go to https://ctru.leeds.ac.uk/privacy/