Thank You for Your Interest in Our 4 week follow up Survey of the Arm Swing Exercise

UNITED HEALTH SERVICES HOSPITALS, INC.

CONSENT TO PARTICIPATE IN A CLINICAL RESEARCH STUDY AND AUTHORIZATION TO USE/SHARE PRIVATE HEALTH INFORMATION FOR RESEARCH
 

Principal Investigator: Josephine Genese, DO, MS

Title of Project: Covid Wellness

You are invited to participate in a research study of the Arm Swing Exercise and Covid-19.  If you just recently started the Arm Swing Exercise, please come back and complete this survey after four weeks of first trying this exercise routine.  We hope to learn how this exercise may be of benefit to people diagnosed with or exposed to Covid-19.   You are being invited because you were on a website and clicked the link. 

If you decide to participate, you will take the survey which is estimated to take less than five minutes.   There are no anticipated potential risks beyond exposure to the topic of the current pandemic. We will not collect any personally identifying information and the survey is anonymous. 

If you have any questions, please ask them before you complete the survey. If you have any additional questions later regarding the research or research related problems, contact Josephine.Genese@NYUHS.org or if you have questions about your rights as a subject, contact Dr. Ronald Harris (Chairman of UHSH Institutional Review Board) at 607-763-5703.

  

Question Title

* 1. Consent To Participate In Research & Authorization To Use And Share Personal Health Information:

I hereby give my consent to participate in this research study and agree that my non-identifying survey answers can be collected, used and shared by the researchers and staff for the research study described in this form. You may print a copy of this page for your records. By continuing, you are also confirming you are age 18 or over and are fluent in English.

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