FAR Research Study Survey

Hello and thank you for taking a few minutes to complete this survey. All survey responses will be completely anonymous. Do not write your name on this survey. Please share your honest thoughts and feedback.

If you decide that you do not want to complete this survey, you do not have to. You also have the option of skipping any questions that you do not feel comfortable answering.

The first 6 questions ask about your experience with severe bleeding and your thoughts about the FAR study.

Question Title

* 1. Have you or a loved one ever had an injury that caused severe bleeding (life-threatening blood loss)?

I have

A family member or loved one has

Question Title

* 2. How do you feel about the following statement: “I believe that it is important for researchers to do the FAR study to learn more about the best way to care for patients with severe bleeding.”

Strongly agree

Agree

Neither agree nor disagree

Disagree

Strongly disagree

Question Title

* 3. Have you been given enough information about the FAR study to say whether or not you think it is okay for researchers to do the FAR study?

Yes

Question Title

* 4. If no, what additional information do you think is important for us to share?

Question Title

* 5. How do you feel about the following statement: “If I was in the emergency room with an injury that is causing severe bleeding, I would be okay with being included in the FAR research study without giving my consent ahead of time.”

Strongly agree

Agree

Neither agree nor disagree

Disagree

Strongly disagree

Question Title

* 6. How do you feel about the following statement: “If my loved one was in the emergency room with an injury that is causing severe bleeding, I would be okay with them being included in the FAR study without giving my consent ahead of time.”

Strongly agree

Agree

Neither agree nor disagree

Disagree

Strongly disagree

Question Title

* 7. Have you decided if you want to participate in the FAR study?

Yes, I will participate

I'm not sure at this time

No, I do not want to participate

Question Title

* 8. What is your age?

Question Title

* 9. What is your gender?

Female

Male

Non binary

I prefer not to answer

Question Title

* 10. What is your race/ethnicity?

White or Caucasian

Black or African American

Hispanic or Latino

Asian or Asian American

American Indian or Alaska Native

Native Hawaiian or other Pacific Islander

Another race

I prefer not to say

Question Title

* 11. What is the highest level of schooling/education that you have finished?

Kindergarten

Grade 1-8

Grade 9-11

Grade 12, high school graduate or GED

College: 4 years

Post Graduate Education: 4+ years

Not Applicable

FAR Research Study Survey

Question Title

* 1. Have you or a loved one ever had an injury that caused severe bleeding (life-threatening blood loss)?

Question Title

* 2. How do you feel about the following statement: “I believe that it is important for researchers to do the FAR study to learn more about the best way to care for patients with severe bleeding.”

Question Title

* 3. Have you been given enough information about the FAR study to say whether or not you think it is okay for researchers to do the FAR study?

Question Title

* 4. If no, what additional information do you think is important for us to share?

Question Title

* 5. How do you feel about the following statement: “If I was in the emergency room with an injury that is causing severe bleeding, I would be okay with being included in the FAR research study without giving my consent ahead of time.”

Question Title

* 6. How do you feel about the following statement: “If my loved one was in the emergency room with an injury that is causing severe bleeding, I would be okay with them being included in the FAR study without giving my consent ahead of time.”

Question Title

* 7. Have you decided if you want to participate in the FAR study?

Question Title

* 8. What is your age?

Question Title

* 9. What is your gender?

Question Title

* 10. What is your race/ethnicity?

Question Title

* 11. What is the highest level of schooling/education that you have finished?

Question Title

* 12. What town/city do you live in?

Question Title

* 13. Use the space below to provide any questions, concerns, or comments that you want to be shared with the FAR study research team

FAR Research Study Survey

Question Title

* 1. Have you or a loved one ever had an injury that caused severe bleeding (life-threatening blood loss)?

Question Title

* 2. How do you feel about the following statement: “I believe that it is important for researchers to do the FAR study to learn more about the best way to care for patients with severe bleeding.”

Question Title

* 3. Have you been given enough information about the FAR study to say whether or not you think it is okay for researchers to do the FAR study?

Question Title

* 4. If no, what ﻿additional information do you think is important for us to share?

Question Title

* 5. How do you feel about the following statement: “If I was in the emergency room with an injury that is causing severe bleeding, I would be okay with being included in the FAR research study without giving my consent ahead of time.”

Question Title

* 6. How do you feel about the following statement: “If my loved one was in the emergency room with an injury that is causing severe bleeding, I would be okay with them being included in the FAR study without giving my consent ahead of time.”

Question Title

* 7. Have you decided if you want to participate in the FAR study?

Question Title

* 8. What is your age?

Question Title

* 9. What is your gender?

Question Title

* 10. What is your race/ethnicity?

Question Title

* 11. What is the highest level of schooling/education that you have finished?

Question Title

* 12. What town/city do you live in?

Question Title

* 13. ﻿Use the space below to provide any questions, concerns, or comments that you want to be shared with the FAR study research team

* 4. If no, what additional information do you think is important for us to share?

* 13. Use the space below to provide any questions, concerns, or comments that you want to be shared with the FAR study research team