Informed Consent

INFORMED CONSENT FORM

For Survey Participants 

You are being asked to participate in a research project entitled: OT Interventions and Multiple Sclerosis

We are graduate students at Russell Sage College in the Occupational Therapy (OT) department. We are conducting a survey to gain insight into how Occupational Therapists can more effectively implement treatments to individuals with Multiple Sclerosis (MS). Please take our 10-15-minute survey so we can gain a better understanding of the relationship between OT and MS.

There is a chance that you may become emotionally upset while answering these questions. You may exit the survey at any time, or skip any questions.

We are looking for individuals who have a diagnosis of Multiple Sclerosis (MS). If you are interested, please click here.

 1.  We are conducting a survey to gain insight into how Occupational Therapists can more effectively implement treatments for individuals with Multiple Sclerosis (MS).

 2.   The nature of your participation consists of a brief 15-minute anonymous survey. At the end of the survey, there will be an option to participate in an interview at a later time if interested.

 3.   We are asking that you complete the survey to the best of your ability. Surveys are confidential and data will be stored on a password protected computer. This research is being conducted by student investigators, Natalie F. and Jamie K., under the guidance of Dayna Maniccia, DrPH, MS, primary investigator and research advisor.

By participating, you will be helping to advance the research of occupational therapy interventions in relation to individuals with Multiple Sclerosis to better the treatment and care received.

I have been given an opportunity to read and keep a copy of this Agreement and to ask questions concerning the study. Any such questions have been answered to my full and complete satisfaction.

If there are questions, please email Dayna Maniccia at manicd@sage.edu.

This research has received the approval of The Sage Colleges Institutional Review Board, which functions to insure the protection of the rights of human participants. If you, as a participant, have any complaints about this study, please contact: 

Dr. Theresa Hand, Provost
The Sage Colleges
65 1st Street, Troy, NY 12180
518-244-2069, handt@sage.edu

Question Title

* 1. By clicking this box, I, having full capacity to consent, do hereby volunteer to participate in this research study.

By clicking on this box, I agree that I am 18 years or older.

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