Communication Disability Centre The Aphasia Registry at The University of Queensland What is the process for joining the Aphasia Registry?
1. Contact the Aphasia Registry 2. We will send you the: • • • Aphasia Registry Information Sheet Aphasia Registry Consent Form Personal Details Form
3. If you want your name put on the Aphasia Registry: • • • Read the Information Sheet Read and sign the Consent Form
Write your information on the Personal Details Form
•
Mail us your Consent Form and Personal Details Form. We will give you a return addressed envelope.
•
We can help you complete the forms.
How can I contact the Aphasia Registry?
Telephone:
07 3365 2891
Fax:
07 3355 1877
Email:
l.worrall@uq.edu.au
Or return the below form to: Professor Linda Worrall Communication Disability Centre Division of Speech Pathology School of Health and Rehabilitation Sciences The University of Queensland ST LUCIA QLD 4072
• I am interested in joining the Aphasia Registry • Please send me some information Name: _____________________________________________ _____________________________________ _____________________________________ _____________________ Postcode: _______ Telephone Number: ( ___ ) ______________________________
Postal Address: