Online Survey Consent Script
We are asking you to take part in a research study because we are trying to learn more about the care you receive for primary sclerosing cholangitis. You will be asked to complete an online survey about your disease, symptoms, perceived care, and social aspects of your life. Completing the survey will take about 20 minutes. You will not receive any material compensation for answering this survey. You can choose to complete or skip any of the questions.
Dr. Cynthia Levy has disclosed that she has a personal interest related to this study.Please ask any questions to assure yourself that this relationship has not overly influenced the
conduct of this research study. If you require further information, please contact the study doctor
or HSRO at 305-243-3195 to ask questions or discuss concerns.
If you have any questions about reviewing disclosures of financial interest or the conflict of
interest management process at the UM, please call 305-243-0877.
Participation is voluntary. There are no negative consequences if you don't want to take it. If you
start the survey, you can always change your mind and stop at any time. Taking part in the study
involves no risks. You will not benefit directly from being in this research study. We will not ask
for your name or any other information that might identify you.
If you have any questions or concerns about the research, please feel free to contact Dr. Cynthia
Levy or Dr. Adrielly Martins (305-302-2474 or axm8717@med.miami.edu). If you have
questions regarding your rights as a research participant, contact the University of Miami,
Human Subject Research Office at hsro@miami.edu or (305)243-3195.
By selecting "I consent to participate" below, this means you consent to participate in this
research project
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