Thank you for your interest in our research studies. USC HEAL is currently running a number of research studies and would like to ask that you complete a few questions about yourself and your personal history to see which study would be most appropriate for you. This should only take 2-5 minutes. In order to ensure your health and safety, we ask that you are as honest and accurate as possible.
If you participate in this online screener, we will keep your screening responses and contact information in order to reach out to you about future research studies that you may be eligible for. Please note, that if you are eligible for one of our studies, you will be required to show us your government issued photo ID that clearly shows your name, date of birth, and a photo of you. This is so that we can confirm that we are conducting the study visit with the correct person.
Your screening data and contact information will be stored in a secure, password-protected data repository available only to USC HEAL researchers. We may use your identifiable data in future USC HEAL studies, and / or distribute your data and contact information to USC HEAL researchers for future USC HEAL studies, without your additional informed consent. Data will be stored for as long as the data repository is active and approved by USC. If you later want to withdraw your data from the repository, you can do so by emailing firstname.lastname@example.org
; however, it may not be possible to destroy any data that has already been shared with and / or utilized by USC HEAL researchers.
You will not be compensated for this online screener, or for any research findings that result from use of your data. Some of the questions may make you feel uneasy or embarrassed. You can choose to skip or stop answering any questions you don’t want to. There is a small risk that people who are not connected with this online screener will learn your identity or your personal information. We will keep your records for this online screener confidential as far as permitted by law. You won’t benefit directly from this online screener, but your participation may help us identify people who are be interested in participating in future USC HEAL research studies. This online screener is voluntary. An alternative is to not participate. Your decision to participate or not will not impact your participation status in other USC HEAL studies.
If you have questions, concerns, complaints, you can call the principal investigator Adam M. Leventhal, PhD, at (323) 442-2598
. This research has been reviewed by the USC Institutional Review Board (IRB), which reviews and monitors research studies to protect the rights and welfare of research participants. If you have any questions about your rights as a research participant or you have complaints about the research, you may contact the IRB at (323) 442-0114
or by email at email@example.com
If you are interested, please complete the brief survey below and someone from our team will contact you to ask a few additional questions. By completing this survey, you are agreeing to allow us to maintain this information and to contact you about future studies you may be eligible for.
You have the right to receive a copy of this consent language. If you like to maintain this consent for your records and would like to download this, on your browser go to your "File" then click "Print" and "Save as PDF”.