You are being invited to complete a survey regarding the transition from acute to chronic Temporomandibular Disorder called ‘TMD’, a type of facial pain. Based on your responses, you may be contacted to participate in the study or for further information. We are interested in understanding what may predict health wellbeing associated with facial pain.
The survey will ask you a few questions about your health in relation to your temporomandibular joint (TMJ) disorder. The completion of the questionnaire may take on average 5 minutes. This survey will help the research team identify potential participants with TMD, and to obtain some information about your pain and disability in relation to your condition. If you are subsequently contacted about study participation, you will be receive more information about the study and be given another consent form for study participation if you choose to take part.
There is no compensation for your participation. Your participation is voluntary. You may choose to participate now and decide to stop your participation at any time. There are no risks, disadvantages, or any side-effects to completing this survey. There is no direct benefit to participate in this study. You will be asked to provide your contact information (phone number and email address). Based on the evaluation of your answers, you may be contacted. All information obtained about you during this study will be treated conﬁdentially.
If you have any question about this study, please contact Dr. Ana Velly: 514-340-8222 ext 22932, or at email@example.com. For any question regarding your rights as a research participant, please contact Rosemary Steinberg (Jewish General Hospital), local commissioner of complaints and quality of service, at 514-340-8222 ext. 25833 or Pascale Valois (Montreal General Hospital), local commissioner of complaints and quality of service, at 514-934-1934 ext. 44285.
I acknowledge that I have read the above information and I am aware of the purpose of this screening questionnaire. I freely consent to complete this screening questionnaire. I am aware that I may be contacted at a later date about taking part in this study. I am at least 18 years of age, and I am the person completing the screening questionnaire.