INFORMED CONSENT FOR ANONYMOUS SURVEY
 
You are invited to participate in a research study titled “How periods of relapse and remission affect treatment compliance in patients with Relapsing-Remitting Multiple Sclerosis”.
 
This study is being conducted by Mark Buys, co-investigator, a Physician Assistant student at Rocky Vista University under the faculty advising of Darcy Solanyk, principal investator.
 
The purpose of this study is to gather information regarding patients with multiple sclerosis and adherence to their treatment plan for their disease. The results of the study will be collected and then analyzed in an attempt to identify any possible trends or associations. The findings will be used in the student’s capstone project for graduation from the PA program.
 
Participation in this study is entirely voluntary at all times.  You can choose not to participate at all or to leave the study at any point. If you decide not to participate, or to leave the study, there will be no penalty or loss of benefits to which you are entitled, or any effect on your relationship with the researcher(s), or any other negative consequences. 
 
You are being asked to take part in this study because you are a patient with relapsing-remitting MS and are receiving treatment for the disease.
 
If you agree to participate, you will be asked to fill out a brief survey about your experience with MS, as well as with your treatment. This survey should take around 1-2 minutes to complete.
 
The survey will be collected via SurveyMonkey.
 
All of your responses to this survey will remain anonymous and cannot be linked to you in any way. No personally identifying information about you will be collected at any point during the study, and your survey will be identified only with a random number. You are free to withdraw from this study at any time. However, once you submit your completed survey, there will be no way to withdraw your responses from the study because the survey contains no identifying information.
 
Study data will be kept in a digital format using Google and Microsoft Excel. Only Mark Buys, the primary investigator will have access to the data.
 
Any risks to you associated with this study are not expected to be greater than anything you encounter in everyday life.  While you will not experience any direct benefits from participation, information collected in this study may benefit others in the future by helping to benefit others that may be struggling with MS themselves.
 
If you have any questions regarding the survey or this research project in general, please contact the principal investigator, Darcy Solanyk, at dsolanyk@rvu.edu, mark.buys@rvu.edu or her co-investigator, Mark Buys, at mark.buys@rvu.edu
 
If you have any questions about your rights as a research participant, please contact the Rocky Vista University IRB Compliance Administrator at 720-874-2481 or ldement@rvu.edu.
 
By completing and submitting this survey, you are indicating your consent to participate in this study.

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* 1. What therapy are you currently using to treat your RRMS?

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* 2. How often are you required to take your medication?

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* 3. How often do you miss a medication dose during periods of disease remission?

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* 4. How often do you miss a medication dose during periods of disease relapse?

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* 5. How many disease relapses have you had in the last five years?

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* 6. What is the number one reason you miss a medication dose?

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