[Consent Screen 1]
[display]
You are one of about 10,000 people in the United States who are being asked to take a survey about a new medication. The survey will take about 30 minutes to complete.
[Consent Screen 2]
[display]
This survey is being conducted by RTI International (RTI), an independent nonprofit research organization, on behalf of the U.S. Department of Health and Human Services. RTI is working with GfK to conduct this survey but is not affiliated with GfK in any way. If you have questions about this survey, please contact Panel Relations at 1-800-782-6899, and someone will direct your questions to the appropriate researchers at RTI.
Possible Risks or Discomforts
We do not expect that any of the survey questions will make you uncomfortable or upset; however, if they do, you can refuse to answer any question or you may take a break at any time during the survey. There is also a potential risk of loss of confidentiality. Every effort will be made to protect your information, but this cannot be guaranteed.
Benefits
Your responses are very important because they will help researchers understand how people make decisions about medications.
If you have any questions about your rights as a survey participant, you may wish to contact the RTI Office of Research Protection. If you contact Panel Relations at 1-800-782-6899 and indicate that you would like to contact the RTI Office of Research Protection, someone will provide you with the appropriate contact information.
As with other surveys you receive from GfK, the privacy and confidentiality of your information is of the highest importance, and we are committed to maintaining a secure environment in which you can participate. All information collected in this survey will be kept confidential to the extent provided by law. Your name and your e‑mail address will not be shared outside of GfK, and they will not be associated with your answers or used in any report.
[Consent Screen 3]
[radio]
[prompt if skip]
Consent1. If you have read the previous screens and agree to participate, please click the Yes button. If not, click the No button.
Yes, I agree to participate. [Continue with next section]
No, I do not agree to participate. [Go on to next question]
[radio]
[prompt if skip]
[if consent1=no or skip]
Consent2. Are you sure you don't want to participate? Your opinions are important to us. Please select the Yes button to continue this survey. Select the No button to exit.
Yes, I agree to participate. [Continue with next section]
No, I do not agree to participate. [End survey]
| File Type | application/msword |
| File Title | [Consent Screen 1] |
| Author | rli |
| Last Modified By | Mizrachi, Ila |
| File Modified | 2014-10-28 |
| File Created | 2014-10-28 |