Section 1. Privacy and consent
1. Do you consent to the Department collecting the information requested in Citizen Space about you, including any sensitive information, for the purposes of this consultation?
Please select all that apply
(Required)
Checkbox:
Ticked
Yes, I consent
Checkbox:
Unticked
No, I do not consent
2. Do you consent to the Department publishing your response to this consultation, on the Published responses page, after the consultation close date?
Please select one item
(Required)
Radio button:
Unticked
Yes, I consent to my full response being published
Radio button:
Ticked
Yes, I consent to my response being published but keep my name private
Radio button:
Unticked
Yes, I consent to my response being published but keep my name and organisation private
Radio button:
Unticked
No, I do not consent to my response being published
Section 2. Contact details
5. Are you providing input as an individual or on behalf of an organisation?
Please select all that apply
(Required)
Checkbox:
Unticked
Individual
Checkbox:
Unticked
Clinical or health professional/organisation
Checkbox:
Unticked
Pharmaceutical sector
Checkbox:
Ticked
Government
Checkbox:
Unticked
Consultancy
Checkbox:
Unticked
Medical technology sector
Checkbox:
Unticked
Academic/researcher
Checkbox:
Unticked
Consumer group/organisation
Checkbox:
Unticked
Other
6. If you are providing input on behalf of an organisation, please provide the name of your organisation.
Organisation name
(Required)
HTA Consumer Consultative Committee