SECURE VAULT
Stroke trials office
☎ +44 (0)115 823 1770
ssSIP
ssSIP –
S
wallow
S
trength and
S
kill training with biofeedback
I
n
P
ost-stroke dysphagia
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ssSIP participant contact details
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Participant's initials:
ssSIP trial number:
Surname:
Forename(s):
Middle initials:
Permanent address:
Post code:
Follow-up telephone number:
Temporary residence:
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permanent
residence
has been given above.
Alternate telephone number:
Email address:
Hospital number:
(
not
centre ID)
GP title/name:
GP practice name:
GP address:
GP post code:
GP telephone:
Comments:
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