Online Consent Form

Characterising gastric interstitial Cells of Cajal changes within diabetic patients and its effect on gastric emptying

I hereby consent to participate in the above named research project.

I acknowledge that:

  • I have read the participant information sheet (or where appropriate, have had it read to me) and have been given the opportunity to discuss the information and my involvement in the project with the researcher/s
  • The procedures required for the project and the time involved have been explained to me, and any questions I have about the project have been answered to my satisfaction.

I consent to:

  • Use of any removed or discarded tissue for research. Research will involve the separation and enrichment of a specific cell type, Interstitial Cells of Cajal.
  • Molecular analysis (proteomic, transcriptomic, cell imaging, and electrophysiological techniques) will be carried out on isolated interstitial cells of Cajal.
  • I consent for my data and information provided to be used for this project.
  • I understand that my involvement is confidential and that the information gained during the study may be published but no information about me will be used in any way that reveals my identity.

This study has been approved by the Human Research Ethics Committee at Western Sydney University. The ethics reference number is: H11683. If you have any complaints or reservations about the ethical conduct of this research, you may contact the Ethics Committee through Research Engagement, Development and Innovation (REDI) on: Tel +61 2 4736 0229 or Email humanethics@westernsydney.edu.au. Any issues you raise will be treated in confidence and investigated fully, and you will be informed of the outcome.

Participation in this study
Please fill for an email copy of consent form

Online Consent Form based on version 3.1 (15 March 2018)

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