Recruitment

NHS number

Date of Birth

Patient initials *

Please initial boxes

I have read the Patient Information Sheet dated 17 Dec 2025 (Version 1.0) for the above study and I have had the opportunity to ask questions and discuss the research study and I am satisfied with the answers to my questions.

I have received enough information about this study.

I understand that my participation is voluntary and that I am free to withdraw from the study at any time without giving a reason.

I give my consent for my General Practitioner to be informed in the event of any abnormality being discovered and that the cardiologist will be informed only if we find any abnormality over and above which is already known.

I understand that images collected will be stored on an NHS computer system, and, after my personal details have been removed, may be available to researchers at other institutions in the UK, the EEA, and countries outside the EEA.

I understand that some of the blood samples taken from me may be stored and may be analyzed in the future for markers related to heart disease.

I understand that relevant sections of my medical notes and data collected during the study, may be looked at by individuals from the University of Leeds, from regulatory authorities, or from the Leeds Teaching Hospitals NHS Trust, where it is relevant to my taking part in this research. I give permission for these individuals to have access to my records.

If I were to lose capacity, I understand that data already collected will be kept and used for the purposes of the study.

I agree to take part in this research study and that the general results of the study will be made available to the medical community most likely through publication in a reputable medical journal.

I am willing to be contacted again in the future to receive information about the publication of this study. *YesNo

I am willing to be contacted again in the future with regard to potentially taking part (without any obligation) in further related research studies, or attending for further MRI scans. *YesNo

I would like to receive a summary of the final results when they are available

Thank you for your interest in the IMID-Heart study.