Informed Consent

Informed Consent

As part of a project for the Health Resources and Services Administration (HRSA), Crosby Marketing is conducting this focus group to get your thoughts.

If you decide to be in the group, here are some things you should know:

• It is up to you to decide if you want to be in the group.

• Being in the focus group should not harm you. You may not want to answer every question. You do not have to answer all the questions if you do not want to. If you would like more information about this, please let us know.

• Your name will not be used in any reports. We will take notes. We may also audio-record the group to make sure our notes are correct, but we do not keep these tapes once we have checked our notes. Other people on our team may also be watching the groups so they can hear your ideas, too.

• You will receive money as a thank-you for taking the time to be in the group.

• You can leave the group at any time, or not answer any question, and you still get the money for your time.

• Being in the group will not change any existing relationship you have with HRSA (for example, if you go to a HRSA-funded clinic) or anything else about other Federal programs you may be in.

• If you have any questions, please ask them now. If you think of a question later, please call the person listed below.

• The focus group will last approximately 2 hours.

Contact information: If you have any questions, please contact Mike Cosgrove at 301-951-9200.

Please sign to say that you understand this information and want to be in the focus group.

Print your name: _________________________ Date: _________________________

Signature: _________________________