Glaucomatous Optic Neuropathy Evaluation Project

	Glaucomatous Optic Neuropathy Evaluation Project
REGISTER
Deakin medical school
*First Name:
*Last Name:
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*E-mail:
*Is this your first time register? :


*Training:		* Years of clinical work:	Subspecialty:
What proportion of your clinical work relates to Glaucoma?:
Have you been to disc examination training course FORGE?:	Did you find it helpful?
From where did you hear about GONE?:
	According to your clinical experience, please rate the following disc features according to the order of importance in increasing the suspicion of glaucoma. 1 being most important, 10 being least important.
Peri-papillary atrophy:		Disc size:
CDR:		Rim loss:
Cup depth:		Rim colour:
Neural fibre layer loss:		Presence of disc haemorrhage:
Your suggestion		Your suggestion
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CONFIDENTIALITY Statement

The data derived from this study, including the results, email address and any other personal information supplied, is regarded as confidential and will not be released to any third party and at no time will individual results be released with any identifying data associated.

If you have any comments or concerns about this study please email them to us at mcoote@bigpond.net.au

Thank you for your participation.