University of Manitoba Bannatyne Campus Research Ethics Board Consent Disclosure Statement

On –line Survey Consent Disclosure Statement
Study Name: Physical Assessment in Pharmacy Education and Practice: an evaluation of the value and feasibility of incorporating physical assessment from the care provider and public perspective

Organization: University of Manitoba

Thank-you for accessing the Physical Assessment in Pharmacy Education and Practice Survey on the internet.  This study is being conducted by Dr. Christine Leong, Assistant Professor from the College of Pharmacy at the University of Manitoba

This survey is being conducted to understand the public and healthcare provider perspective on pharmacists performing physical assessments on patients as part of patient care.

Your feedback will be collected through an online survey which will ask you a series of questions and should take about 15 to 20 minutes to complete.

Your participation on this online survey is completely voluntary.   You are not required to provide any personal information such as your name, address or telephone number, and you don’t have to answer any questions you don’t want to.  The survey system will not record your e-mail address or IP (Internet protocol) address. 

The risks of participating are low. Risks of participating in this survey may include tiring from answering questions. 

If you agree to participate in the survey, please note that you must complete the survey in one sitting (in other words, the system won’t let you save your survey responses and return to complete them later). 

Also, please note that when you submit your response. You will not be able to withdraw them as we cannot link the survey responses back to you. All responses are anonymous.

Your participation is important to us and will help us design a program within the Pharmacy curriculum that is meaningful to clinical practice and that will provide value to patient care.  If you have any questions about this survey study, please do not hesitate to contact Dr. Christine Leong at

The study is funded by the National Association of Boards of Pharmacy and the American Association of Colleges of Pharmacy. 

This study has been approved by the University of Manitoba Health Research Ethics Board.

By continuing on and completing the on-line survey you are consenting to participate in the on-line survey.