Anaphylaxis Australia

Research

Anaphylaxis to Australian native ant venoms

The Australian Ant Venom Allergy Study Enrolment Information

NOTE - The following files require Adobe Acrobat Reader Version 6 or later. This can be downloaded for free from:

http://www.adobe.com/products/acrobat/readstep2_allversions.html

STEP 1.

Download Information and Consent Sheets to find out more about the study.

Information and Consent Sheets- ADULT

Information and Consent Sheets- CHILD

STEP 2.

If you wish to be involved in the study, you have two options:

Option 1

Contact the national study centre to discuss your involvement. You may have a choice between participating through the national study coordinating centre, or through a local investigator if one is available in your area.

The national study coordination centre can be contacted by telephone, fax or email:

A/Prof Simon Brown or Ellen MacDonald RN
Emergency Medicine Research Unit
Department of Emergency Medicine, Fremantle Hospital
Alma Street, Fremantle, WA 6160
phone (08) 9431 3733 fax (08) 9431 3073
email: fh.edresearch@health.wa.gov.au

Option 2

Enrol in the study now by email. Follow these steps:

1.		Print out the appropriate Consent Sheet above (Step 1) and complete the form and sign it.
2.		Print out the Release Form, to sign and complete alongside the Initial Questionnaire. This release form will enable us to get copies of your medical records relating to your previous allergic reactions. Release Form
3.		Download the Initial Questionnaire: Initial Questionnaire Note: This is a large file (924 KB) and may take several minutes to download with a dial-up connection.
4.		If you have had more than 4 severe allergic reactions, you will also need to download an Additional Reactions sheet: Additional Reactions Note: This is a large file (452 KB) and may take several minutes to download with a dial-up connection.
5.		The Questionnaire and Additional Reactions forms can be printed and mailed, or the data emailed directly to us to begin the enrolment process immediately. If you do decide to email the data, please print out a copy for a backup.
6.		The Consent and Release Forms must be sent to us by mail or fax before we can complete your enrolment: The national study coordination centre can be contacted by telephone, fax or email: A/Prof Simon Brown or Ellen MacDonald RN Emergency Medicine Research Unit Department of Emergency Medicine, Fremantle Hospital Alma Street, Fremantle, WA 6160 phone (08) 9431 3733 fax (08) 9431 3073 email: fh.edresearch@health.wa.gov.au

IF YOU HAVE PROBLEMS WITH THESE FORMS:

The above forms require Adobe 6 or 7. They also may not work well on an older computer. If you have problems, contact us by email and we can either:

(i) email you an older version files (Adobe 5) or;

(ii) send out a study pack by mail, with a reply-paid envelope to return the completed paperwork.