Patient Story Participation Consent Form

I agree to share my experience of living with Lynch syndrome with Lynch Syndrome Australia (LSA).

I understand that my story can be captured as a short video, as a voice recording or as a written story.

I understand that my de-identified story will appear on the LSA website on the personal stories webpage.

I have been provided with and have read a copy of the Consumer Stories Information Sheet and understand that:

  • Stories which defame health professionals and/or any health care settings, including medical practices, day surgery centres or hospitals will NOT be accepted.
  • Because we have a duty to inform responsibly those who engage with our website, stories which make reference to experimental treatments or medications, including alternative treatments which are not part of mainstream treatments, will need to be reviewed by our editorial team with advice from our scientific advisory committee members, before publication.
  • I can withdraw my consent at any stage.
  • I will have the opportunity to review my story before it appears on the web page.
  • My story will be de-identified (except for where you have given permission to use your own name) and used only for the purpose of the LSA website personal stories webpage.
  • I understand that my contact detail will be protected according the LSA’s Privacy Policy.