MHSC
Senior Moderator
http://www.psych.ubc.ca/~adlab/avianflusurvey.htm
University of British Columbia
Avian Influenza/ Bird Flu Consent Form
<table cellpadding="0" cellspacing="0"> <tbody><tr> <td style="background: white none repeat scroll 0% 50%; vertical-align: top; -moz-background-clip: -moz-initial; -moz-background-origin: -moz-initial; -moz-background-inline-policy: -moz-initial;" align="left" bgcolor="white" height="92" valign="top" width="155">Department of Psychology
2136 West Mall
Vancouver , B.C. Canada
V6T 1Z4
Tel: (604) 822-2755
Fax: (604) 822-6923
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Informed Consent Principal Investigator: Dr. Anita DeLongis, Tel.#: (604) 822-4729 adlab@psych.ubc.ca
The purpose of this study is to gather information that will help us better understand how individuals are understanding, reacting and coping with Bird Flu. Understanding the psychological factors and responses to the threat of Bird Flu infection may help to identify more effective intervention strategies to help people cope with the Bird Flu threat. Potential risks include answering questions on a potentially upsetting topic (Bird Flu infection), however you may benefit from this study by gaining insight into how you are dealing with this threat.
If you choose to participate in this study, you will be asked to participate in an on-line questionnaire on the Bird Flu Virus. Completion of the questionnaire is entirely voluntary and has no effect on your medical care. You have the right to refuse to participate or withdraw from participation without penalty of any kind and the right to terminate your participation at any time.
All information is confidential and will be used for research purposes only. Anonymity is assured, as your name will not appear on the questionnaire. This consent form is not attached to your questionnaire. The data will be securely stored by the principal investigator. The questionnaire consists of 5 parts and takes approximately 15-20 minutes to complete. The survey works optimally on Internet Explorer.
Clicking on the link below ("I consent to participate") indicates that you have understood to your satisfaction the information regarding participation in the research project and agree to participate. In no way does this waive your legal rights nor release the investigators, sponsors, or involved institutions from their legal and professional responsibilities. You are free to not answer specific items or questions in interviews or on questionnaires. You are free to withdraw from the study at any time without penalty. Your continued participation should be as informed as your initial consent, so you should feel free to ask for clarification or new information throughout your participation. If you have further questions concerning matters related to this research, please contact:
If you are concerned about your rights or treatment as a research subject you may contact the Director of UBC Office of Research Services and Administration at 604-822-8598.
Please print this page to keep for your records and reference
University of British Columbia
Avian Influenza/ Bird Flu Consent Form
2136 West Mall
Vancouver , B.C. Canada
V6T 1Z4
Tel: (604) 822-2755
Fax: (604) 822-6923
</td></tr> </tbody></table>
Informed Consent
The purpose of this study is to gather information that will help us better understand how individuals are understanding, reacting and coping with Bird Flu. Understanding the psychological factors and responses to the threat of Bird Flu infection may help to identify more effective intervention strategies to help people cope with the Bird Flu threat. Potential risks include answering questions on a potentially upsetting topic (Bird Flu infection), however you may benefit from this study by gaining insight into how you are dealing with this threat.
If you choose to participate in this study, you will be asked to participate in an on-line questionnaire on the Bird Flu Virus. Completion of the questionnaire is entirely voluntary and has no effect on your medical care. You have the right to refuse to participate or withdraw from participation without penalty of any kind and the right to terminate your participation at any time.
All information is confidential and will be used for research purposes only. Anonymity is assured, as your name will not appear on the questionnaire. This consent form is not attached to your questionnaire. The data will be securely stored by the principal investigator. The questionnaire consists of 5 parts and takes approximately 15-20 minutes to complete. The survey works optimally on Internet Explorer.
Clicking on the link below ("I consent to participate") indicates that you have understood to your satisfaction the information regarding participation in the research project and agree to participate. In no way does this waive your legal rights nor release the investigators, sponsors, or involved institutions from their legal and professional responsibilities. You are free to not answer specific items or questions in interviews or on questionnaires. You are free to withdraw from the study at any time without penalty. Your continued participation should be as informed as your initial consent, so you should feel free to ask for clarification or new information throughout your participation. If you have further questions concerning matters related to this research, please contact:
Dr. Anita DeLongis
Stress and Coping Lab
604-822-4729
Stress and Coping Lab
604-822-4729
If you are concerned about your rights or treatment as a research subject you may contact the Director of UBC Office of Research Services and Administration at 604-822-8598.
Please print this page to keep for your records and reference
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