Better Health Together

Title

Given name *

Surname *

Email Address *

Contact number

Address Line 1

Address Line 2

Suburb

State

Postcode

Date of birth

Gender *

Do you identify as a member of the LGBTQIA+ community? *

YesNo

Do you identify as Aboriginal or Torres Strait Islander? *

Do you have lived experience of an illness or chronic condition? *

YesNo

Do you have lived experience as a carer? *

YesNo

Are you living with a disability? *

YesNo

Do you identify as neurodiverse? *

YesNo

Is English your first language? *

YesNo

If no, would you require the help of an interpreter?

YesNo

What type of activities would you like to be involved with at QIMR Berghofer? *

Select all that apply

Sharing my health story with researchers to help inform the direction of research projectsHelp review lay descriptions of research for grant applications or other documentsHelp craft public messaging for the recruitment of research participantsGive feedback on the way the Institute communicates with the communityProvide advice about how research findings can be translated into clinical practice, policy or educationMeet with researchers to talk about new research ideasParticipate in working groups or committees that help inform the way the Institute worksServe as a member of the QIMR Berghofer Consumer Advisory GroupParticipate in media stories related to my area(s) of interest or experience

What is your health area of interest or experience? *

Select all that apply

If you selected other, please specify here

If you selected cancer, are there particular types of cancer you have knowledge of or experience with?

Select all that apply

If you selected other, please specify here

How did you hear about our Better Health Together register? *

If you selected other, please specify here

I would like to receive the Better Health Together e-newsletter.

This is sent every other month and includes any involvement opportunities that are available with QIMR Berghofer and its researchers, as well as other stories or activities that might be of interest.

YesNo

What other ways are you happy to be contacted about available involvement opportunities related to your area(s) of interest and experience?

EmailPhone

I would also like to receive the following future communications from QIMR Berghofer:

Better Health Together

Better Health Together Registry Sign-up Form

Interest and Experience

Communication Preferences