TRAK-SA

Please read each of the following statements carefully.
If you agree with all of the statements, you are able to register an interest to participate in enrolling in the TRAK-SA Study.

I confirm that I am aged 18 or over
I have access to mobile, wireless or wired internet
I am fluent in English/Arabic

Please review the patient information sheet for further information about the study if you have any questions or concerns about taking part.

Your Name

Your full name:

Contact Information

Your Mobile/Telephone number:

Your Email Address:

Your address:

Preferred mode of contact

Preferred mode of contact: Telephone
Email
Secure video conferencing

The TRAK-SA team are able to communicate with you remotely with your preferred mode of contact.
If you have specific communication requirements, e.g. the use of any aids, please provide details: (please note that due to COVID-19, we are not currently conducting any face to face visits and all contact will be remote)

Choose a password for your account

Password to access your account: (Your password must be at least 8 characters long and include at least one upper and lower case letter and a number)

By submitting this Expression of Interest, I confirm that I am happy to be contacted by the Trak-SA
study team to discuss my potential participation in the TRAK-SA study