Investigator Contact Information:

You are being asked to give consent for Jessica Harasym O'Byrne, or a qualified member of her study team to contact you at some time in the future to tell you more information about a research study. This does not mean you have to participate.

If yes, you will be contacted at a later date. Please include your contact information below.  

By submitting this form you authorize the disclosure of your name, telephone number, and/or email to the research team for the purpose of being contacted to learn more about the research study "The Impact of Post-Concussion Communication Difficulties on Daily Life".

Every effort will be made to safeguard your contact information. Although access to this information will be limited, there is a small chance that this information could be inadvertently disclosed or inappropriately accessed. You have been made aware of the reasons why the contact information is needed and the risks and benefits of consenting or refusing to consent. This consent is effective immediately. Your consent to be contacted can be revoked by you at any time.