Consent

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To join ONLOOP and receive your personalized information toolkit, please review the consent form below. You will need your reference number, which is on the top left of page 1 of your study letter.

Currently, only individuals who received a study letter are eligible to take part in ONLOOP. Please complete this consent form only if you received a study letter.

If you did not receive a letter and would like to join our waitlist or learn about future research, please email onloop.info@sickkids.ca.

Study:
ONLOOP: Evaluating a new surveillance and support system for survivors of childhood cancer in Ontario

By signing up for ONLOOP, I confirm that I understand that:

I am being asked to participate in a research study.
I have received and read the information regarding this study.
I am revealing information about myself, including that I meet this research study’s eligibility criteria.
Ontario Health will disclose my personal health information to the researcher, including the details necessary to prepare my personalized health toolkit and personalized reminders regarding recommended tests.
My study data may be viewed by the SickKids Research Ethics Board and a representative of Clinical Trials Ontario to ensure that the collected data follows proper laws and guidelines. Further details about this process can be found on page 5 of the study invitation letter.
I may refuse to participate in the study at any time, without consequence.
My decision, whether or not to participate, will have no effect on my current or future healthcare.

I am over the age of 18 and understand the information that has been presented.

I want to participate in this research study. I agree to provide the researcher with my family doctor’s or nurse practitioner’s contact information, and in doing so, I consent to the researcher contacting them for the purposes of the ONLOOP research study.

I want to participate in this research study. I do not have a family doctor or nurse practitioner.

I want to participate in this research study. I have a family doctor or nurse practitioner, but I do not wish to provide their contact information and do not consent to the researcher contacting them.

I do not want to participate in the ONLOOP Study.

AND / OR

I do not want Ontario Health to contact me about any research study, in future.

YOUR REFERENCE NUMBER (you can find this on the top left of page 1 of your invitation letter):

This project has been reviewed by the Research Ethics Board at The Hospital for Sick Children. Please contact the Office of the Research Ethics Board at 416-813-8279 if you have any questions about your right as a participant.

Ontario Health is an organization committed to ensuring accessible services and communications to individuals with disabilities. To receive any part of this document in an alternate format, please contact our Communications Department at 1-855-460-2647, TTY (416) 217-1815, or publicaffairs@ontariohealth.ca

Consent

Study:ONLOOP: Evaluating a new surveillance and support system for survivors of childhood cancer in Ontario

Study:
ONLOOP: Evaluating a new surveillance and support system for survivors of childhood cancer in Ontario