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hDHigHWAzJ9Dt92P6cHRKnfGayuSSxfXLFczh477sIKIIQYHEEoNvfhsz8BeIzVDWSN8Z6d7PwCmgUUN5dPssBQzvijvG5I3c5XzcxUKkZmxTZEW

Paediatric Hips - Expression of Interest

Please complete the questions below to register interest for the study "Paediatric Hip Shape and Function".

Please note that questions are worded on the assumption that you are a parent/guardian registering interest on behalf of your child. If you are aged 4-17 years and registering interest on your own behalf, please note that we will require a parent/guardian to attend the research appointment to sign consent.

If you have any difficulties in completing this survey, please feel free to contact Matilda Krywanio directly at matilda.krywanio@adelaide.edu.au or on 8313 0821 for more information regarding the study.

First and last name of a parent or guardian

* must provide value

Phone number

* must provide value

Email address

* must provide value

What is your child's first and last name?

* must provide value

What is your child's date of birth?

* must provide value

D-M-Y

What is your child's gender?

* must provide value

If gender is other, please let us know your child's preferred pronouns

Your child's approximate height, in cm

* must provide value

Your child's approximate weight, in kg

* must provide value

Has your child previously had a surgery on their lower limb (e.g., knee, ankle, hip, leg) or been diagnosed with any leg or hip disease (including broken bones)?

* must provide value

Yes

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Has your child injured any part of their legs within the last month?

* must provide value

Yes

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If yes, has this injury affected the way your child walks?

* must provide value

Yes

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Has your child been diagnosed with any congenital, neurological, or musculoskeletal condition which affects the way they walk, or the way their bones develop? This includes developmental dysplasia of the hip, cerebral palsy, or muscular dystrophy, for example.

* must provide value

Yes

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The image below shows an MRI safety checklist. With your child in mind, would you answer 'yes' to any of the questions?

MRI Safety Checklist, from Dr Jones and Partners

* must provide value

Yes

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If yes, please let us know which conditions apply

* must provide value

Would your child have any difficulty in understanding instructions in written or spoken English, explained by a researcher or by a parent/guardian?

* must provide value

Yes

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You have selected an option that triggers this survey to end right now.

To save your responses and end the survey, click the 'End Survey' button below. If you have selected the wrong option by accident and/or wish to return to the survey, click the 'Return and Edit Response' button.