Lipoedema Quality of Life Questionnaire | Kinvara Private Hospital

The researcher (Mr Vasu Karri) requests your consent to participate in a study about the effect of lipoedema liposuction on your quality of life. The answers you provide in this questionnaire will be used by Mr Karri in the study.

This consent also asks your permission to use related observations as data in the study (such as post-op pain scores, total volume of fat removed, etc).

Participation in this study is completely voluntary. If you decide not to participate there will be no negative consequences. You may stop participating at any time and/or decide not to answer any specific question.

All data will be anonymised and kept securely for a period of 10 years after the questionnaire submission, in accordance with the Data Protection Act 2018. You are entitled to access the information you have provided at any time while it is in storage under Freedom of Information legislation.

If you have any questions, or would like a copy of this consent, please contact us at Kinvara Private Hospital, 2 Clifton Lane, Rotherham, S65 2AJ or enquiries@kinvarahospital.co.uk.

By submitting this form, you are indicating that you have read the description of the study, are over the age of 18, and agree to the terms as described.

Thank you in advance for your participation.

Consent

I voluntarily agree to participate in this research study.I understand the purpose and nature of the study, which is to evaluate the effect of lipoedema liposuction on my quality of life. I will be required to complete a quality of life questionnaire before and after surgery.I understand that I can withdraw at any time or refuse to answer any question without any consequences of any kind.I understand that all information I provide will be treated confidentially, and that if the results of this research are published, my identity will remain anonymous.I understand that this signed consent form and completed questionnaire will be retained in a secure database that only Mr Karri and nominated individuals have access to.

Consent for Participation in a Research Study: Improvement in Quality of Life After Lipoedema Liposuction

Patient Details