INTERVIEWS - Antenatal Models of Care and the effect on breastfeeding rates after discharge (Consumer)

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Closes 1 Jun 2023


Please read the Participant Information and Consent Form before completing the questions below.

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Declaration by Participant

Declaration by Participant

- I have read the Participant Information Sheet, or someone has read it to me in a language that I understand.

- I understand the purposes, procedures and risks of the research described in the project.

- I have had an opportunity to ask questions and I am satisfied with the answers I have received.

- I freely agree to participate in this research project as described and understand that I am free to withdraw at any time during the project without affecting my future health care.

- I understand that I can print a copy of this document or can be emailed a copy upon request.

- I understand that, if I decide to discontinue the research project treatment, a member of the research team may request my permission to obtain access to my medical records for collection of follow-up information for the purposes of research and analysis.

1. Name of Participant:
2. Date of birth of Participant:



3. Do you wish to participate in this research?
4. I would like to be informed of results from the data collected within this study
5. Please provide your best contact number
6. Please list the best time(s) of day that you can be contacted or include any days that it may be easier to contact you. If we contact you at an inconvenient time, we will arrange a better time to speak with you. Please note, that the call you receive from us may show as 'No Caller ID'.