Consent Form

In order to determine who is eligible for our studies, we have created a questionnaire that can be accessed and completed on the Internet.

The advantages to this questionnaire are that:

• It can be completed at any time that is convenient for you
• You can spend as much time as you like
• It can be completed from the privacy of your home
• If you are not eligible for our current study, you may be eligible for future studies. With your permission your information can be kept on record so that we can contact you in the event that you may be eligible for other studies.

The potential disadvantages are:

• The data are transmitted via the internet
• The data are stored on a server and contain your name, address and phone.

What is done to minimize these disadvantages:

• Transmission is accomplished via encryption technologies like those used by your bank when you bank on-line.
• The data you submit is securely sent to a computer housed within our laboratory and is within the secured network that belongs to the URMC.
• Only UR Sleep Research Laboratory Staff have access to the information provided on your questionaire.

I understand the advantages and disadvantages of completing this questionnaire and choose to complete the survey at this time.