Participant Consent Form

RESEARCH PROJECT TITLE: Determining Barriers to HPV Vaccination for Non-School Aged Individuals as Reported by Family Physicians, Obstetricians and Gynecologists, and Sexual Health Clinic Staff Across Canada

Thank you for your interest in this research project. Project personnel include Dr. Cory Neudorf (Principal Investigator), Dr. Thilina Bandara (Co-Principal Investigator), Mika Rathwell (Project Coordinator), and Sarah Valentine (Medical Student Researcher).

Should you have questions or concerns about the research project please contact:

Dr. Cory Neudorf, Principal Investigator
Professor, Department of Community Health and Epidemiology, University of Saskatchewan
President, Urban Public Health Network
Email cory.neudorf@usask.ca
Telephone 306-966-2276

Should you have questions or concerns about completing this contact form please contact:

Sarah Valentine, Medical Student Researcher
Email: sav737@usask.ca

By completing this contact form you will be consenting to participate in the research project and will be contacted in the near future with the appropriate survey.

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* 1. Have you read and do you understand the information included on the Participant Information Sheet and Consent Form?

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* 2. Do you consent to participate in this research?

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* 3. What is your work email address?

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* 4. What is your position or title?

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* 5. Do you consent to Project Personnel reaching out to you for clarification about answers if necessary?

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* 6. If you have any questions at this time, please leave them below and we will get back to you.

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