Registration of Interest for LATER (ANZ 0501)


Information on Privacy and Confidentiality
I am interested in learning more about the LATER study and give consent for my health information to be stored and used by the ANZBCTG for this purpose only. Please note: the consent box must be ticked to complete this online page.
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Have you completed menopause?
Have you previously been diagnosed with breast cancer?
Was your breast cancer treated with hormonal therapy for at least 4 years?
Have you completed your hormonal therapy at least 1 year ago?
Are you currently free of breast cancer?
Title:
First name:*
Last name:*
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Suburb:
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Evening:
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Hospital Preference:
Where did you hear about LATER?

Privacy and Confidentiality All information about you and your interest in the LATER study will be used and stored according to the requirements of the Privacy Laws of Australia or New Zealand. Only staff involved with the study will have access to the information. Data collected about you for the purposes of the study will be viewed by your study institution (i.e. the hospital or clinic you attend for the study) and the Australian coordinating centre, the ANZBCTG. Return to top