Withdrawal

By completing the form below, you will be withdrawing your consent to participate in the research study for the CogDrisk. Withdrawing from the study WILL NOT affect your relationship with The University of New South Wales, NeuRA, or the researchers involved in the study.

Your Name*

Email*

Questionnaire ID

Withdrawing consent*

I am withdrawing my consent and I understand that any information already published and/or not linked to my identity cannot be withdrawn from the research

Personal Data Options

I am withdrawing my consent to participate in further components of this research and provide my permission for the research team to retain and/or use information collected about me which I have provided for the purpose of this research

I would like any identifiable information collected about me which I have provided for the purpose of this research study withdrawn

Your thoughts, questions, or comments (200 characters max)

Withdrawal

Discover your personal risk profile