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Consent Form

Congratulations, you meet the criteria for our study! We ask you now to complete a consent form to take part in the research study, so tell us a little more about you and your history of back pain, and fill out some questions so that we better understand your back pain.

Consent Form

I confirm that I have read and understood the Participant Information Sheet.

Agree

I understand that my participation is voluntary and that I am free to withdraw at any time without giving a reason and without my rights being affected in any way.

Agree

I give my consent to be invited for an individual interview (which will be audio-recorded), and for those records to be reviewed by persons involved in the study at Ulster and the lead partner in Lund University, Sweden.

Agree

I understand that the researchers will hold all information and data collected securely and in confidence and that all efforts will be made to ensure that I cannot be identified as a participant in the study (except as might be required by law) and I give permission for the researchers to hold relevant personal data.

Agree

I agree to take part in the above study

Agree

___________________________________________________________

E-mail address:

Age

Gender

Female

Male

Other

Prefer not to say

Duration of back pain (years)

Type of work

Sedentary (mostly sitting e.g. office worker, driver, professional)

Light manual (mostly standing or walking e.g. retail worker, health care worker, cook)

Heavy manual (heavy labour e.g. farming, construction, cleaner)

Unsure or other

The European Commission support for the production of this publication does not constitute an endorsement of the contents which reflects the views only of the authors, and the Commission cannot be held responsible for any use which may be made of the information contained therein.