Question Title

* 1. Thank you for your interest in our study. Please review the study information below and indicate your interest in participating.

UNIVERSITY OF CALIFORNIA LOS ANGELES

STUDY INFORMATION: Conscious Dance Survey

Kelsey Laird, Ph.D., and Helen Lavretsky, M.D., M.S, from the Semel Institute for Neuroscience and Human Behavior at the University of California, Los Angeles (UCLA) are conducting a research study.

You were selected as a possible participant in this study because you have participated in some form of conscious dance. For the purposes of this survey, we are defining "conscious dance" as intentional, freeform, primarily nonverbal dance that takes place in a group setting.

Your participation in this research study is voluntary.

Why is this study being done?

This study is designed to determine who participates in conscious dance and why, as well as any effects they notice from their participation.

What will happen if I take part in this research study?

If you volunteer to participate in this study, you will be asked to complete a survey online. This survey will include questions about your experiences with conscious dance as well as questions about your emotional and physical well-being.

How long will the research study take?

Participation will take roughly 10 minutes.

Are there any potential risks or discomforts that I can expect from this study?

There are no anticipated risks or discomforts.

Are there any potential benefits if I participate?

You will not directly benefit from your participation in the research.

The results of the research may inform future clinical trials employing components of conscious dance.

Will information about me and my participation be kept confidential?

Personally identifying information such as your name and date of birth will not be requested from you in this study. Information that is obtained in connection with this study will remain confidential. Data will be password protected and only members of the research team will be granted access. Data be disclosed only with your permission or as required by law.

What are my rights if I take part in this study?

You can choose whether or not you want to be in this study, and you may withdraw your consent and discontinue participation at any time.

Whatever decision you make, there will be no penalty to you, and no loss of benefits to which you were otherwise entitled.

You may refuse to answer any questions that you do not want to answer and still remain in the study.

Who can I contact if I have questions about this study?

If you have any questions, comments or concerns about the research, you can talk to the one of the researchers. Please contact:

Principal Investigator: Kelsey Laird, Ph.D. at (310) 351-9353 or klaird@ucla.edu

Faculty Sponsor: Helen Lavretsky, M.D., M.S. at (310) 794-4619 or HLavretsky@mednet.ucla.edu

UCLA Office of the Human Research Protection Program (OHRPP):
If you have questions about your rights as a research subject, or you have concerns or suggestions and you want to talk to someone other than the researchers, you may contact the UCLA OHRPP by phone: (310) 206-2040; by email: participants@research.ucla.edu or by mail: Box 951406, Los Angeles, CA 90095-1406.

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