Research Form

If you are a researcher and looking for consumer for your research project, you can tell us about your research project via the form below:

About yourself

About your project

Title of Research project*

PDF related to Research*

Type of Research* Clinical Trial Patient experience research Consumer perspectives research Consumer involvment in committee Student Project Other

</fieldset>

<legend>At which stage of your project are you seeking input from Kidney Health Australia?</legend>

<label><input name="researchSeek[]" type="checkbox" value="feedback"/><span>Feedback / input on planning / Study design</span></label>
<label><input name="researchSeek[]" type="checkbox" value="demonstrate"/><span>Demonstrating consumer involvement on grant applications</span></label>
<label><input name="researchSeek[]" type="checkbox" value="implement"/><span>Implementation of project</span></label>
<label><input name="researchSeek[]" type="checkbox" value="promote"/><span>Promotion of research / survey to consumers via our social media & consumer networks</span></label>
</fieldset>

<legend>Please provide a brief description of your research project<span style="color: red;">*</span></legend>

<legend>How does your research relate to people with kidney disease?<span style="color: red;">*</span></legend>

<legend>Does your research project have ethics approval?<span style="color: red;">*</span></legend>

<label for="yes"><input type="radio" id="html" name="researchEthics" value="yes" required=""/>Yes</label>
<label for="pending"><input type="radio" id="html" name="researchEthics" value="pending" required=""/>Pending</label>
<label for="no"><input type="radio" id="html" name="researchEthics" value="no" required=""/>No</label>
<label for="notrequired"><input type="radio" id="html" name="researchEthics" value="notrequired" required=""/>Not Required</label>
<textarea name="researchEthicsDetails" rows="2" placeholder="If yes, please provide details."/></fieldset>

<legend>Are you looking for paid or in-kind support from Kidney Health Australia?</legend>

<legend>What is the time commitment and/or frequency required for consumers?<span style="color: red;">*</span></legend>

<select name="researchFreq" required=""><option value="" selected="">Select</option><option value="once">Once-off</option><option value="monthly">Monthly</option><option value="quaterly">Quaterly</option><option value="annually">Annually</option><option value="other">Other</option></select><textarea name="researchFreqDetails" rows="2" placeholder="If other, please provide details."/></fieldset>

<legend>Would consumers be reimbursed for their time or are you seeking in kind support?<span style="color: red;">*</span></legend>

<select name="researchReimburse" required=""><option value="" selected="">Select</option><option value="paid">Paid for involvement</option><option value="incentive">Incentive / voucher for participation</option><option value="expenses">Expenses covered</option><option value="volunteers">Volunteers</option></select><textarea name="researchReimburseDetails" rows="2" placeholder="Please clarify."/></fieldset>

<legend>How will working with Kidney Health Australia benefit your research?</legend>

<legend>How will working with you benefit Kidney Health Australia / people with kidney disease?</legend>

<legend>How do you intend to keep KHA/consumers informed of the outcomes of your research project?</legend>

<legend>How long do you want your listing displayed on our website?<span style="color: red;">*</span></legend>

<legend>This research is appropriate for: Who are you looking for?<span style="color: red;">*</span></legend>

<select name="researchAudience" required=""><option value="" selected="">Select</option><option value="kidneyDisease">Person with early stage kidney disease</option><option value="dialysis">Person on dialysis / transplant</option><option value="family">Family / carer</option><option value="healthProfessional">Health professional</option><option value="other">Other</option></select><textarea name="researchAudienceDetails" rows="2" placeholder="If other, please provide details."/></fieldset>

<legend>
Contact details for enquiry<span style="color: red;">*</span><br /><em style="font-size:80%; font-weight:normal;">(please note this will be published on our website so consumers can contact you)</em>
</legend>

<label><input name="researchContact[]" type="checkbox" value="email" required=""/><span>Email</span></label>
<label><input name="researchContact[]" type="checkbox" value="phone" required=""/><span>Phone</span></label>
<label><input name="researchContact[]" type="checkbox" value="website" required=""/><span>Website</span></label>
<label><input name="researchContact[]" type="checkbox" value="download" required=""/><span>Download</span></label>
</fieldset>

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