Participant Consent Form

Participant Consent Form

DARE Disability Support Logo
Nepean Blue Mountains Local Health District logo

DARE Disability Support and Nepean Blue Mountains Local Health District are working together to discover what good communication in hospital looks like for people with communication disabilities, in particular, people with intellectual and developmental disabilities.

DARE Disability Support Logo
Nepean Blue Mountains Local Health District logo

DARE Disability Support and Nepean Blue Mountains Local Health District are working together to discover what good communication in hospital looks like for people with communication disabilities, in particular, people with intellectual and developmental disabilities.

DARE Disability Support Logo
Nepean Blue Mountains Local Health District logo

DARE Disability Support and Nepean Blue Mountains Local Health District are working together to discover what good communication in hospital looks like for people with communication disabilities, in particular, people with intellectual and developmental disabilities.

Nurses talking to a patient lying in a hospital bed

We want to know about:

  • The way that healthcare workers talked to you about things,
  • How you felt when talking to healthcare workers, and
  • How important information about you was shared between health staff and your support people.
Nurses talking to a patient lying in a hospital bed

We want to know about:

  • The way that healthcare workers talked to you about things,
  • How you felt when talking to healthcare workers, and
  • How important information about you was shared between health staff and your support people.
Nurses talking to a patient lying in a hospital bed

We want to know about:

  • The way that healthcare workers talked to you about things,
  • How you felt when talking to healthcare workers, and
  • How important information about you was shared between health staff and your support people.
A lady looking away thoughtfully with question marks drawn above her head

We would like you to tell us about your story and share your ideas with us so we can make communication better for everyone.

A lady looking away thoughtfully with question marks drawn above her head

We would like you to tell us about your story and share your ideas with us so we can make communication better for everyone.

A lady looking away thoughtfully with question marks drawn above her head

We would like you to tell us about your story and share your ideas with us so we can make communication better for everyone.

Lady presenting to nurses

By filling in the form below you’re telling us that you’re happy for us to share your thoughts with nurses and doctors and other health care staff so they can improve.

Lady presenting to nurses

By filling in the form below you’re telling us that you’re happy for us to share your thoughts with nurses and doctors and other health care staff so they can improve.

Lady presenting to nurses

By filling in the form below you’re telling us that you’re happy for us to share your thoughts with nurses and doctors and other health care staff so they can improve.

A person with a disability and a lady having a discussion

You can ask a support person to help you fill in this form if you would like.

A person with a disability and a lady having a discussion

You can ask a support person to help you fill in this form if you would like.

A person with a disability and a lady having a discussion

You can ask a support person to help you fill in this form if you would like.

    Personal details being filled out

    Two people on ipad

    lady holding thumbs up and thumbs down

    Now, we also need your consent to use your survey response.
    I give my consent for my survey response to be used by the My Health My Communication project.

    Thank you for your time. We need your consent to use your survey response. Without your consent we cannot collect your response.

    Kathryn Woods

    Once you have completed the survey that will appear after you submit this form, Kathryn Woods, the project manager, would like to find a time talk to you about the last time you went to hospital. Would you like to talk to Kathryn about the last time you went to hospital?

    Lady holding her hand up to say no

    Kathryn will never ask you to do or say anything that you are not okay with. You can change your mind at any time.

    Pictograms

    You can tell or show Kathryn the best way to communicate with you. We can use your communication aids. Kathryn will also bring pictograms and easy read information to your meeting.

    Emails on a laptop

    Kathryn can talk to you over the phone, through emails, or she can talk to you in person. How would you like to talk to Kathryn?

    A lady having her temperature taken

    If you would like to meet Kathryn at DARE, she will talk to you before the meeting to make sure you do not have Covid 19. You will need to sign in, use hand rub and have your temperature checked before using the meeting room, and if you want, Kathryn can wear a mask to the meeting.

    A man being filmed

    Are you okay with having a video or your voice recorded when we talk? This will be used to teach healthcare workers how they can improve. We will show you any videos before they're used for training purposes to make sure you're happy with them first.

    If you're happy with all of your responses above please press the button below to send your responses to us. You will be redirected to the survey.
    Your name, address and contact details will not be given to anyone and will be always be kept safe by DARE.

      Personal details being filled out

      Two people on ipad

      lady holding thumbs up and thumbs down

      Now, we also need your consent to use your survey response.
      I give my consent for my survey response to be used by the My Health My Communication project.

      Thank you for your time. We need your consent to use your survey response. Without your consent we cannot collect your response.

      Kathryn Woods

      Once you have completed the survey that will appear after you submit this form, Kathryn Woods, the project manager, would like to find a time talk to you about the last time you went to hospital. Would you like to talk to Kathryn about the last time you went to hospital?

      Lady holding her hand up to say no

      Kathryn will never ask you to do or say anything that you are not okay with. You can change your mind at any time.

      Pictograms

      You can tell or show Kathryn the best way to communicate with you. We can use your communication aids. Kathryn will also bring pictograms and easy read information to your meeting.

      Emails on a laptop

      Kathryn can talk to you over the phone, through emails, or she can talk to you in person. How would you like to talk to Kathryn?

      A lady having her temperature taken

      If you would like to meet Kathryn at DARE, she will talk to you before the meeting to make sure you do not have Covid 19. You will need to sign in, use hand rub and have your temperature checked before using the meeting room, and if you want, Kathryn can wear a mask to the meeting.

      A man being filmed

      Are you okay with having a video or your voice recorded when we talk? This will be used to teach healthcare workers how they can improve. We will show you any videos before they're used for training purposes to make sure you're happy with them first.

      If you're happy with all of your responses above please press the button below to send your responses to us. You will be redirected to the survey.
      Your name, address and contact details will not be given to anyone and will be always be kept safe by DARE.

        Personal details being filled out

        Two people on ipad

        lady holding thumbs up and thumbs down

        Now, we also need your consent to use your survey response.
        I give my consent for my survey response to be used by the My Health My Communication project.

        Thank you for your time. We need your consent to use your survey response. Without your consent we cannot collect your response.

        Kathryn Woods

        Once you have completed the survey that will appear after you submit this form, Kathryn Woods, the project manager, would like to find a time talk to you about the last time you went to hospital. Would you like to talk to Kathryn about the last time you went to hospital?

        Lady holding her hand up to say no

        Kathryn will never ask you to do or say anything that you are not okay with. You can change your mind at any time.

        Pictograms

        You can tell or show Kathryn the best way to communicate with you. We can use your communication aids. Kathryn will also bring pictograms and easy read information to your meeting.

        Emails on a laptop

        Kathryn can talk to you over the phone, through emails, or she can talk to you in person. How would you like to talk to Kathryn?

        A lady having her temperature taken

        If you would like to meet Kathryn at DARE, she will talk to you before the meeting to make sure you do not have Covid 19. You will need to sign in, use hand rub and have your temperature checked before using the meeting room, and if you want, Kathryn can wear a mask to the meeting.

        A man being filmed

        Are you okay with having a video or your voice recorded when we talk? This will be used to teach healthcare workers how they can improve. We will show you any videos before they're used for training purposes to make sure you're happy with them first.

        If you're happy with all of your responses above please press the button below to send your responses to us. You will be redirected to the survey.
        Your name, address and contact details will not be given to anyone and will be always be kept safe by DARE.