Informed Conset

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* 1. You are being invited to complete a survey. This survey is being done by the University of New England.  
 
The purpose of this survey is understand what types of treatment people get for urine leak.  If you agree to take part in this survey, you will be asked about your urine leak issues and type of treatment. It will take you about 40 minutes to complete. 

You may not directly benefit from this survey. We hope that your answers may help others understand best treatments for people with urine leak.

We believe there are no known risks with this survey; however, as with any online related activity the risk of a breach of confidentiality is always possible.  To the best of our ability your answers in this study will remain confidential.  We will lessen any risks by not asking for your name and result will be kept secure.

Doing this survey is completely voluntary and you can not do it at any time.  You are free to skip any question that you choose.

If you have questions about this project, you may contact the Jennifer Gunderman at jgundermanking@une.edu or (207) 221-4000.  
 
By clicking “I agree” below you are stating that you are at least 18 years old, have read and understood this consent form and agree to participate in this survey.  You can print a copy of this page.

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* 2. In what state or U.S. territory do you live?

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* 3. How old are you?

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* 4. What is your gender?

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* 5. Which race/ethnicity best describes you? (Please choose only one.)

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* 6. What is the highest level of school that you have finished?

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* 7. What type of health insurance do you have?

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* 8. Does your health insurance cover most of your health care costs?

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