PUBLIC INQUIRY: Contaminated Blood & Blood Products

Submitting Evidence

Witness & Expert Evidence Questionnaire

The Inquiry wishes to give all interested parties the opportunity to share their experiences, knowledge and or expertise for review. The information you provide will assist the Inquiry to decide if more detailed written evidence is required or whether or not you should be called to give oral evidence.

Please note, the form can be completed and submitted on-line or printed off and posted or faxed to the Independent Public Inquiry.

Details of the postal address can be found on the Contacts page.

Your Details  
First Name*
Last Name*
Job Title
State (US only)
  * - mandatory fields

1. If you are a patient, dependant and or a bereaved family member, would you please in the space below outline in approximately 700 words your experience and knowledge in connection with Contaminated Blood and Blood Products.

It would be very helpful to the Inquiry if you would describe as best as possible the following:- When and under what circumstances were you first advised that you or a family member were suffering from Hepatitis C and or HIV or vCJD? Also how have these illnesses affected you and or your family?

In addition, it would be helpful to have some brief information on the following:

Dates, places, medical conditions/symptoms before, during and after (both diagnosed and undiagnosed) exposure to contaminants, and any other relevant information.

2. Are you in receipt of any funding from either the Skipton Fund and or the MacFarlane Trust or The Eileen Trust?

3. If you are a Medical Expert or member of the Scientific Community do you feel your experiences, knowledge and or expertise (including research) could be useful to the inquiry? And if so why? Please describe in approximately 700 words.

4. Have you ever given evidence on any previous inquiry or panel review in connection with Contaminated Blood and Blood products, and if so what was the Inquiry and when did you give your evidence?
5. Are you willing for both your written and or oral evidence to be published by the Inquiry, if you are selected?

Please do not send any personal items (such as medical records, photos etc) to the Inquiry office with your submission of evidence form. These items may be required at a later stage, if it is deemed necessary by the Inquiry.