A portrait of PH with lung disease: Permission to share your experiences

Thank you for sharing your experiences of PH with lung disease. Please complete the form below to confirm your permission for us to include your words in our study.

My permission

Name(Required)

The transcription from your call will be analysed, and parts of it may be published, as part of this study. Your name, and any other identifiable information, will not be included. Please tick below to confirm your consent for this.

I consent

We may also like to share your experiences as part of a feature in our member magazine or on our website. Please tell us what you give your consent for in this way:

You may use my words in your member magazine without my name

You may use my words in your member magazine with my name

You may use my words on your website without my name

You may use my words on your website with my name

Signature (you can use either your finger or your mouse)(Required)

Date(Required)