Expression Of Interest Form
Yes, I am happy for a researcher to contact me about participating in this project.
Part 1: Your Contact Details
First Name *
Last Name
Address
Suburb
State *
Preferred telephone number (day) *
Email address
(Please include only if you check your emails regularly)
Preferred contact time/s
Part 2: Your experience of infertility and/or fertility treatment
What is your age? *
Has a doctor made a diagnosis of infertility? *
> If no, please tell us a little about your situation.
How old were you when you were diagnosed with infertility / self-identified as being infertile? *
Have you experienced any fertility treatment/s? *
> If yes, please provide brief details:
What sex was recorded on your original birth certificate?
What is your gender? (e.g. female, non-binary, male, etc)
Part 3: Additional questions (optional)
The reason we ask the following questions is that it is important for us to get as wide a range of perspectives and experiences as possible within the group of people we interview. However, you do not have to answer them if you don’t wish to.
Relationship status: (e.g. partnered, single, divorced etc)
Do you have children?
Clear selection
Are you currently working and / or studying?
> If you are working, what is your occupation?
What is your cultural or ethnic background?
How would you describe your sexual orientation / sexuality?
What, in your understanding, is the cause of infertility in your case?
Please let us know if there is anything else about your situation / experiences you would like to share at this stage:
Queries:
Telephone: (03) 9925 2800 Email: MCHRI-HealthtalkAustralia@monash.edu

This research project is being conducted by RMIT University, the Monash Centre for Health Research and Implementation (Monash University) and other partners.

Project ID: NHMRC CRE APP1171912

Ethics approval: RMIT University Human Research Ethics Committee (22758-2020)

Lead Investigators: Professor Renata Kokanović (RMIT University), Associate Professor Jacqueline Boyle (Monash University. CRE-WHIRL Lead Investigator: Professor Helena Teede (Monash University)
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