Forms and documents
All the forms are here for you to read. The on-line system is secure and simple to use and has been developed to keep our costs low and make joining lifepool as quick and easy for women as possible.
If you prefer, we are happy to mail out a document pack to you. Send an email to Lisa at lifepool@petermac.org (click here) to request a pack. You can also print these forms at home if you like but please ensure you print single sided, black & white documents. After you have completed them, please post back to us at the lifepool project using the following Reply Paid address (you don’t need to use a stamp):
NBCF BreastScreen Cohort Project
Attn. L. Devereux
Research Division, Peter MacCallum Cancer Centre
Reply Paid 86395
Locked Bag 1
A’BECKETT STREET VIC 8006
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.
2. Lifepool Consent Form, Questonnaire & 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 permit lifepool 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
Using this form, 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 |