Background information and clinic details

You are about to undertake a survey exploring the prevalence of, and the clinical and pathological characteristics for elapid snake envenomation of small animals in Queensland, Australia.

Your views are very important to us!

This project aims to fill the knowledge gap of the prevalence and geographical distribution of small animal elapid snake envenomation in the state of Queensland, Australia. Data will be collected on assumed or confirmed snake bite cases presented to animal veterinary clinics. This study is vital for a better understanding of the clinical signs and pathological findings associated with various venomous snake species, and will in turn allow for improved accuracy of diagnosis.

We would like to invite you to participate in this survey conducted by the University of Queensland. Please read the participant information sheet accompanying this form and complete the consent form below.

Your participation is voluntary. All information from the survey will remain confidential to the research team. None of the information that I provide will be described or portrayed in any way that will be identify me in any report on the study 



This study adheres to the Guidelines of the ethical review process of The University of Queensland and the National Statement on Ethical Conduct in Human Research. Whilst you are free to discuss your participation in this study with project staff (contact details below), if you would like to speak to an officer of the University not involved in the study, you may contact the Ethics Coordinator on 3365 3924.

Principal Investigator
Ludovica Valenza, Ph: 0439828702
Email: ludovica.valenza@uqconnect.edu.au


PLEASE ENSURE THAT YOU READ AND ANSWER ALL THE QUESTIONS ON THIS SURVEY .

THANK YOU VERY MUCH FOR YOUR COOPERATION IN THIS IMPORTANT STUDY TO INVESTIGATE SNAKE ENVENOMATION IN OUR COMPANION ANIMALS.

PLEASE CLICK THE FOLLOWING BOX TO AGREE TO PARTICIPATE IN THIS SURVEY.

Question Title

* 1. I agree to participate in this survey.

Question Title

* 2. Name of veterinarian

Question Title

* 3. Name of clinic

Question Title

* 4. Postcode of clinic

Question Title

* 5. Phone number (only used to follow-up on questions, if necessary)

T