Mamma Print

Statement by Participant I hereby consent to take part in this study. I understand that I will receive a signed copy of
this consent form for my records.

YK main Consent (Full Name)

(Signature)

10/08/2022 (Date DD/MM/YYYY)

Statement by Consenter (Investigator/designee) I have discussed this study with the above-named
participant. The participant appeared to fully understand the information provided about the study.

YK PI (Full Name)

YK PI (Signature)

Principal Investigator (Project Role)

10/08/2022 (Date DD/MM/YYYY)

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Statement by Participant

YES, I hereby consent to take part in this study. I understand that I will receive a signed copy of this
consent form for my records.

YK Optional Consent (Full Name)

(Signature)

10/08/2022 (Date DD/MM/YYYY)

Statement by Consenter (Investigator/designee) I have discussed this study with the above-named
participant. The participant appeared to fully understand the information provided about the study.

YK PI (Full Name)

YK PI (Signature)

Principal Investigator (Project Role)

10/08/2022 (Date DD/MM/YYYY)

Mamma Print