Expression of interest in SPROCKET for families

 

We are inviting families with children with complex health needs in North London to take part in one-hour interviews and/ or three-hour group workshops. Research participants will be compensated for their time and expertise.

Please complete this form to let us know if you are interested in hearing more about how to take part in SPROCKET, led by University College London (UCL) and Great Ormond Street Hospital (GOSH).

By completing this form you are not consenting to take part in the study. You only consent to being contacted about taking part. Deciding to take part in the research is completely up to you and you can change your mind at any time.

When you submit this form, it will not automatically collect your details like name and email address unless you provide it yourself. The information from these forms will be managed by GOSH, kept in secure UK-based data centres and will be deleted as soon as we make contact with you.

1. What is your name? *

 

2. What is your email address? *

 

3. What is your phone number?

 

4. Do you live in one of these North London boroughs - Barnet, Camden, Enfield, Haringey or Islington? *

 

5. Does your child (under 18 years) have complex health needs? (Our definition of complex health needs is: multiple, severe and persistent physical, mental, or developmental conditions requiring integrated, ongoing support from health, education and social services). *