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AGDS_CellO eConsent Form

Title Australian Genetics Depression Study: Anti-depressant Cell-omics Study
Short Title AGDS-CellO
Protocol Number 2023/HE000050
Project Sponsor The University of Queensland
Coordinating Principal Investigator Professor Naomi Wray
Associate Investigator(s) Professor Ian Hickie
Professor Nick Martin
Dr Sonia Shah
Professor Sarah Medland
Dr Enda Byrne
Dr Jacob Crouse
Dr Brittany Mitchell
Location The University of Queensland
Participant Details
ⓘ This can be found on the invitation email you received to participate in this study.
Please type the date in yyyy-mm-dd format. (e.g. 2023-07-19)
Residential Address
Postal Address (If different to residential address)

Declaration by Person Responsible

I have read the Participant Information Sheet, or someone has read it to me in a language that I understand. I agree to participate and provide information and biological samples as required. I consent to participate under the following conditions:

  • I understand the purposes, procedures and risks of the research described in the project.
  • I have had an opportunity to ask questions and I am satisfied with the answers I have received.
  • I have agreed to provide biological samples and their use has been explained and accepted by me including the generation of genetic information by sequencing my genome.
  • I understand that all data pertaining to me including my DNA I have provided (but not my name or address) may be made available to researchers in the future, some of whom may have commercial interests.
  • I donate my biological sample freely for these purposes and waive any claim to commercial rights arising from this work.
  • I understand that I will be given a signed copy of this document to keep.
  • I understand that data from my previous participation in AGDS QIMRB study related to this research will be linked to this study.
  • I freely agree to participating in this research project as described and understand that I am free to withdraw at any time during the research project without affecting my future health care.
Genetic Research Findings

Please select only one option:

Storage and Future Use of Biological Samples

In respect to the storage and future use of my samples for:

1. Genetic analysis

I give permission for the use of my samples and its derivatives for the purpose of:

2. Peripheral blood mononuclear cells (PBMCs) for downstream application of generating lymphoblastoid cell lines (LCLs)

I give permission for the use of my samples and its derivatives for the purpose of:

3. Peripheral blood mononuclear cells(PBMCs) for the downstream application of generating induced Pluripotent Stem Cells (iPSC) lines and differentiated organoids

I give permission for the use of my samples and its derivatives for the purpose of:

Other General Information
Declaration by the participant
(please print)
Please type the date in yyyy-mm-dd format. (e.g. 2023-07-19)

Note: All parties signing the consent section must date their own signature

V1.2_27 June 2023