Consent to Participate

THE MOUNT SINAI HEALTH SYSTEM
ICAHN SCHOOL OF MEDICINE AT MOUNT SINAI
RESEARCH INFORMATION SHEET
                                                                                
Study ID #: HS# 15-00894                Form Version Date:  2/16/2016

Title: Medical Marijuana Clinician Survey

Researcher: Jake Rosenberg, MD
                    1 Gustave Levy Place, New York, NY
                    212-659-9127

The purpose of this research study is to assess clinician knowledge, attitudes, and experiences about marijuana and psychiatric conditions. You are being asked to take part in this study because you are a health care practitioner.

Being in a research study is completely voluntary. You can choose not to be in this research study. You can also say yes now, and change your mind later. 

If you agree to take part in this research, you will be asked to complete an anonymous online survey. The survey will consist of 18 questions. Your participation in this study will take about ten minutes. We anticipate that at least 300 clinicians will participate in this research study.

You can choose not to answer any question you do not wish to answer. You can also choose to stop taking the survey at any time. You must be at least 18 years old to participate. If you are younger than 18 years old, please stop now.

The possible risks to you in taking part in this research are:

-       No expected risks

The possible benefits to you for taking part in this research are:

-       Furthering knowledge in this field of study.

There is no risk for loss of confidentiality, as IP address and other identifiable information will not be collected. This will ensure protection of your identity as a research subject. This survey is anonymous. In any publication about this research, your name or other private information will not be used.

If you have any questions about this research, please contact Jake Rosenberg, MD at
212-659-9127. You can also call the Program for the Protection of Human Subjects Office at 212-824-8200.

This project was determined to be exempt from federal human subjects research regulations.


* 1. Do you consent to participate in this research survey?

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