BENEFITS ASSOCIATED WITH THE SURVEY
The Study is for research purposes only. You may not receive any direct benefits from your participation in the Study. However, information learned from the Study may help other people in the future by allowing us to gain insight into a range of issues relevant to clinical trial design, regulatory submissions, marketing strategies, payer value determinations and care and services research involving those with Alzheimer’s disease or other dementia or mild cognitive impairments.
RISKS ASSOCIATED WITH THE STUDY
Some of the survey questions may make you feel uncomfortable or raise unpleasant memories. You are free to skip any question.
Data obtained through the Study will be de-identified and presented through summary findings that will be shared with you and publicly by Sponsor. In addition, data obtained from the Study may be presented at academic conferences, or may be published in medical journals. However, in this case, your name, address, or any other identifiable information will not be transmitted to these outside parties.
Further, we may need to share data with an IRB and federal oversight agencies, such as OHRP. Should any data be shared that contains your health information we will do so on the condition that your confidentiality be fully protected and secured. However, there is a chance your information could be breached and further disclosed if these entities do not adhere to confidentially provisions they promised. By signing this form, you acknowledge the possibility that these acts might occur. Please be assured that we will give you full consideration for protecting your personal information and will comply with all applicable laws and regulations. However, we can never fully guarantee the confidentiality of all your personal information.
We have no plans to routinely offer you financial compensation for surveys fielded by the A-LIST or share the profits from the commercialization of any products, processes, or services developed from your information. However, you will not lose any legal rights to which you are entitled by agreeing to participate in this research. Also, there is no cost to you for taking part in this study. There may be times when longer surveys or other research opportunities that we tell you about warrant compensation – the situations will be specifically identified in the email or offer that you receive introducing the project.
VOLUNTARY PARTICIPATION AND WITHDRAWAL
Choosing Not to Participate
You are free to choose to not take part in the Study. Your participation in the Study is voluntary, and deciding not to take part will involve no penalty or loss of benefits to which you are otherwise entitled. You do not have to accept the terms in this form; however, if you do not accept them, you cannot take part in the Study.