Register

Questionnaire 1
Demographic
Patient information
Client number
Birthday




  • I have been given sufficient information about this research tool and the opportunity to receive further answers for my concerns/questions in the future.
  • My participation in this project is voluntary. There is no explicit or implicit coercion whatsoever to participate.
  • It is clear to me that at any point of time I am fully entitled to withdraw from participation without any consequence.
  • I have the right not to answer any of the questions. If I feel uncomfortable in any way during the session with the healthcare professional, I have the right to withdraw from the session.
  • I have been given the explicit guarantees that, if I wish so, the healthcare professional will not identify me by name or function in any reports using information obtained from this session, and that my confidentiality as a participant in this study will remain secure. In all cases subsequent uses of records and data will be subject to standard of GDPR legislation.
  • I have been given a copy of this consent form co-signed by the healthcare professional.
  • I agree to receive further information on Digi-Ageing project