University of Wisconsin
Consent to Participate in Online Research
Study Title: Web-Based
Wellness and Health Assessment: Perceptions of Health Providers
Person Responsible
for Research: Dr. Fatemeh “Mariam” Zahedi,
Dr. Joseph Weitzer and Gaurav Bansal
Study Description: The purpose of this research study is to
study the users’ perceptions related
to the online health providers. Approximately 700 subjects will participate in this study.
If you agree to participate, you will be asked to complete a survey
that will take approximately 15
minutes to complete. The questions
will ask about the users’ perceptions about the online health websites, their
general health status and demographics.
Risks / Benefits: Risks
to participants are considered minimal. There will be no costs for participating,
nor will you benefit from participating other than to further research, and the
chance to win four $100 cash prizes.
Confidentiality: Your
responses are completely confidential and no individual participant will ever be
identified with his/her answers. Data
from this study will be saved on a password protected computer for 20 years. Only Dr. Fatemeh “Mariam” Zahedi, Dr. Joseph Weitzer
and Gaurav Bansal will have access to the information.
Voluntary Participation: Your participation
in this study is voluntary. You may
choose to not answer any of the questions or withdraw from this study at any time
without penalty. Your decision will
not change any present or future relationship with the
University
of Wisconsin
Milwaukee.
Who do I contact
for questions about the study:
For more information about the study or study procedures,
contact Dr. Fatemeh “Mariam” Zahedi at zahedi@uwm.edu
or (414) 229-6454 (office ph.)
Who do I contact
for questions about my rights or complaints towards my treatment as a research subject? Contact the
UWM IRB at 414-229-3173 or irbinfo@uwm.edu
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