Verteporfin photodynamic therapy for neovascular age-related ...

Verteporfin photodynamic therapy for neovascular age-related ... Verteporfin photodynamic therapy for neovascular age-related ...

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144 Appendix 1College of Ophthalmologists, which represents eye specialists,has set up a body of people to monitor the study while it isbeing carried out. This body includes eye specialists, publichealth specialists and a representative from the MacularDisease Society, an organisation which represents the interestsof patients with macular degeneration. This body will ensurethat patient confidentiality and health are not jeopardised in anyway.If you have any other questions about the cohort study pleasefeel free to speak with a member of the clinical team lookingafter you. A contact name and number is provided belowNamed contact: -------------------------------Telephone:---------------

DOI: 10.3310/hta16060Health Technology Assessment 2012; Vol. 16: No. 6145Hospital /Institution Headed paperCONSENTI have read or have had read to me the aboveconcerning the treatment of Age Related MacularDegeneration using Visudyne in the UK PDT cohortstudy. All my questions have been answered and I amwilling to allow information on my eyesight and clinicalcondition to be made available to the researchersundertaking this work.I am / am not willing to complete the questionnaires inthe cohort study.I agree / do not agree to my GP being informed aboutmy participation in this study.______________ _____________ __________Date Name of Patient Signature______________ _____________ __________Date Name of Doctor Signature© Queen’s Printer and Controller of HMSO 2012. This work was produced by Reeves et al. under the terms of a commissioning contract issued by theSecretary of State for Health.

144 Appendix 1College of Ophthalmologists, which represents eye specialists,has set up a body of people to monitor the study while it isbeing carried out. This body includes eye specialists, publichealth specialists and a representative from the MacularDisease Society, an organisation which represents the interestsof patients with macular degeneration. This body will ensurethat patient confidentiality and health are not jeopardised in anyway.If you have any other questions about the cohort study pleasefeel free to speak with a member of the clinical team lookingafter you. A contact name and number is provided belowNamed contact: -------------------------------Telephone:---------------

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