LifePool - Australian women finding answers

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NBCF BreastScreen Cohort Project
Attn. L. Devereux
Research Division, Peter MacCallum Cancer Centre
Reply Paid 86395
Locked Bag 1

All the forms are here for you to read.  The on-line system is secure and simple to use.

After you register your interest by emailing name, address, date of birth to us at an email will be sent to you containing a unique ID number and a link to your own consent form and questionnaire. You can complete the questionnaire over as many sessions as you like. There is no time limit and you can close the form and return to it whenever convenient.

If you would prefer to use the paper system, you can print these forms at home but please ensure you print single sided, black and white documents. You can also contact lifepool to request a set in the mail. After you have completed them, please post back to us at the lifepool project using the reply paid address listed on the left of screen, under lifepool logo (you don’t need to use a stamp)

Being part of lifepool is as simple as ' Read 1 - Complete and Sign the documents at 2- post forms to lifepool'.

1. Lifepool Participant Information Form Version 3.0 (PDF) -click to download
This is the form you must read before participating in the lifepool Project. It provides an explanation of how the project will operate and just what you will be asked to agree to. If you would like to be part of the project, you will need to complete the consent form and quesionnaire provided at step 2. below.

2. Lifepool Consent Form, Questionnaire & optional Consent to Medicare & PBS data access V 4.32 (PDF)click to download .

In signing the lifepool consent form, you agree to allow lifepool to collect information about you (as explained in 1. above) and to use this information, along with the information in your Questionnaire, to support research into breast cancer and other women's health issues.

Lifepool Questionnaire:We collect health and lifestyle information from women who agree to be part of the lifepool Project. This information will be stored in a highly secure database. No identifying information is stored in this database, only your confidential Study ID number.

Lifepool Consent form 2 for release of Medicare and PBS information .This second form is an optional part of the consent process. Signing this form will allow lifepool to request information from the Medicare and PBS database over the last 41/2 years. You can still be part of lifepool without signing this second consent form.

Withdrawal of Consent Form Version 1.0 (PDF) - click to download
This is the form you need if you wish to change the way you are participating in the lifepool Project. You can withdraw from the project completely or ask us not to contact you anymore.

Stage 2 PICF for DNA Donation Version 1.0 (PDF) click to download
This second Information and Consent form provides information about donating a sample of DNA for research. Although we ask you to donate a blood sample, you can also choose to donate a saliva sample if you would prefer

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Contact us: 1800 198 082 or 03 8559 6532 Privacy and confidentiality