Consent Form

Purpose: This consent form is a request for your participation in a research study by Joyce E. Neal, a doctoral candidate at Trevecca Nazarene University.  This research is being conducted under the supervision of Dr. Alice Patterson.  The purpose of this study is to determine concerns or issues associated with access to VA healthcare services.    

Voluntary Participation: Your participation in this study is voluntary.  Moreover, you may discontinue participation at any time and for any reason without negative consequences.  If you would like previously submitted survey responses omitted from the study, please contact the researcher using the contact information below.

Explanation of Procedures: You will be asked to complete a survey regarding patient satisfaction.  The online survey will take approximately 15 minutes to complete. 

Confidentiality: The website you have accessed, SurveyMonkey.com, is a secure website that uses the latest data encryption technology to securely collect and store data.  While there is no guarantee the information cannot be intercepted by a third party, the chance of this occurring is extremely unlikely.  Minimal demographic and identifying information will be collected in order to help preserve your privacy.

Your survey data will be maintained in the online database until ready to be used for analysis.  At that time, all data will be downloaded into a password-protected Excel file and stored on a private password-protected computer to which only the researcher has access.  Once the study has been completed, the data will be stored on the investigator’s laptop.  Individual responses will be summarized in a group format, further ensuring that the information you provide remains private.

Discomforts and Risks: Risks from participation in this study are minimal.  One potential risk is an accidental breach of confidentiality.  As outlined above, various steps will be taken to maintain confidentiality.

Expected Benefits: There are no anticipated benefits from participating in this research other than contributing to the advancement of scientific knowledge.

Use of Research Data: The information from this research will be used only for scientific and educational purposes.  It may be presented at scientific meetings and/or published in professional journals or books, or used for any other purposes, which Trevecca Nazarene University considers proper in the interest of education, knowledge, or research.  As noted earlier, data will be analyzed and presented in the aggregate such that all individual responses will be kept confidential.

Approval of Research: This research project has been approved by the Institutional Review Board at Trevecca Nazarene University.

Liability/Limitations: Trevecca Nazarene University, its agents, trustees, administrators, faculty, and staff are released from all claims, damages, or suit, not limited to those based upon or related to any adverse effect upon which may arise during or develop in the future as a result of participation in this research.  Please understand that this release of liability is binding upon you, your heirs, executors, administrators, personal representatives, and anyone else who might make a claim through or under you.

Consent to Participate: By clicking “yes” below and completing the survey, I am authorizing my consent to participate in this study.  I also hereby acknowledge that:

1.      I have read and understand the above description of the study.
2.      I understand that if I participate I may withdraw at any time without penalty.

Should you have any questions/concerns about your rights as a research participant, please contact TNU’s Institutional Review Board at IRB@trevecca.edu

Joyce E. Neal, Doctora

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* 1. If I need help, I can get admitted without any trouble.

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* 2. I am very satisfied with the medical care I receive.

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* 3. It is easy for me to get medical care in an emergency.

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* 4. I am usually kept waiting for a long time when I am at the VA medical facility.

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* 5. I think my VA medical clinic has everything needed to provide complete medical care.

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* 6. The VA medical care I have been receiving is just about perfect.

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* 7. It's hard for me to get medical care on short notice.

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* 8. Sometime I go without the medical care I need because it is too expensive.

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* 9. The office hours where I get medical care are convenient (good) for me.

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* 10. The VA clinic where I get medical care should be open evenings and Saturdays.

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* 11. I have easy access to the VA medical specialists I need.

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* 12. Where I get VA medical care, people have to wait too long for emergency treatment.

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* 13. There are some things about the VA medical care I receive that could be better.

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* 14. Some of the doctors I have seen at the VA lack experience with my medical problems.

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* 15. Places, where I get VA medical care, are very conveniently located.

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* 16. Doctors sometimes ignore what I tell them.

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* 17. All things considered, the VA medical care I receive is excellent.

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* 18. I find it hard to get an appointment for VA medical care right away.

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* 19. I am dissatisfied with some things about the VA medical care I receive.

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* 20. I am able to get VA medical care whenever I need it.

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* 21. Gender

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* 22. Branch of Service

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* 23. Era of Service

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* 24. Type of service

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* 25. Current Healthcare Provider

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* 26. If you agree to an online Zoom 30-minute interview session please list an email or other mode of contact along with your first name.

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