Dental Care Survey

Now that you have met our basic study criteria, we would like to tell you about a study. This study involves research on eating disorders. As a voluntary participant of this study, you will be spending approximately 15 minutes answering questions as part of an online survey. Your responses will be anonymous as no identifying information such as name, address, phone number, e-mail or IP address will be collected.

You are being asked to participate in this study because you have been diagnosed with bulimia nervosa. The aim of the current research is twofold, to explore post-purging dental care behaviors and to learn more about your communication regarding your oral concerns with your dental practitioner. If you agree to take part in this study, you can expect to answer questions related to your diagnosis of bulimia, oral concerns, rituals following purging, comfort level in discussing oral concerns with dentist and factors that might affect this interaction.

Upon completion of this online survey or at any point whenever you choose to discontinue the study, you will be provided with appropriate post-purging dental care as recommended by dentists. If you do not wish to answer a question, you may answer N/A or decide to withdraw from the study altogether at any point.

Your participation in this study may increase our understanding of the interaction between bulimic patients and their dentists, and shed more light on post-purging dental care beliefs and behaviors as experienced by the bulimic patient. Results of this study may be used for research, publications and or presentations at scientific meetings. Since no identifying information is gathered in the survey, participation in this research study will not result in a loss of your privacy. Your participation in this study will involve no cost to you and you will not be paid for your participation in this study.

The current research presents no risks other than what you might feel from thinking about the questions that are asked. You are encouraged to take this survey during business hours of your therapist or other treatment providers so that you may contact them if needed. If you do not have a treatment team, you are encouraged to call the Northwestern 24-hour-crisis line at (312) 926-8100 to discuss your situation or feelings. Any questions you may have about this study may also be directed to the primary investigator, Dr. Jenny Conviser at the following number, (312) 540-9955, during regular business hours. You may also address questions about your rights as a research subject to the Office for the Protection of Human Subjects at (312) 503-9338 or (312) 503-9339.

After reading the material above and having clarified any questions you may have had to your satisfaction, you are asked to provide electronic consent to participate in the study.

This survey is being hosted by Insight Psychological Center, http://www.insightforeating.com/ and like most websites, does not involve a secure connection.

IRB Project Number: STU00009051
Project Expiration Date: 11/2/2011
1. ELECTRONIC CONSENT: Please select your choice below.

Clicking on the "Accept" button below indicates that:

• you have read the above information
• you voluntarily agree to participate
• you are at least 18 years of age

If you wish to participate, please select the Accept button to begin the survey. Print a copy of this consent page for your records. If you do not wish to participate in this study, please select the Decline button, and your session will end.
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