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Welcome!

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CONSENT FORM

What is this study about?

We are conducting a study that will help us understand the impact of the Covid-19 Pandemic on individuals with Multiple Sclerosis (MS), Traumatic Brain Injury (TBI), and Stroke. Very little is known about how the Covid-19 Pandemic has affected the emotional and physical well-being of individuals with neurologic conditions. The information we get from this study will help provide us with information that clinicians can use to help adults with neurologic conditions cope with the effects of the Covid-19 Pandemic.

What will I be doing?

After agreeing to be in this study, you will participate in an online survey which will take roughly 30 minutes to complete. You will be asked questions about you (your age, gender, education level, zip code), your family, about your exposure to Covid-19 and whether your are practicing social distancing, and how you have been feeling and the types of activities you have been doing.

You will be asked to provide your email address so that you can participate in this study. From this point on, after you sign this consent form, you will not be identified by name or email address. Rather, we will collect information about you that does not identify you.

Who will participate?

You must be over the age of 18 to participate. There are different types of people who should participate in this study:

-Adults who have been diagnosed with Multiple Sclerosis

-Adults who have sustained a moderate to severe Traumatic Brain Injury

-Adults who have had a Stroke

-Healthy adults who do not have Multiple Sclerosis, Traumatic Brain Injury or a stroke.

You should not participate in this study if you:

-Are younger than 18

-Have a neurologic illness other than Multiple Sclerosis, Traumatic Brain Injury or Stroke (such as Parkinson’s Disease)

-You have a diagnosis of Schizophrenia or Bipolar Disorder

-You have a current drug or alcohol substance use disorder

By agreeing to be in the study, you are attesting to the fact that you meet the above criteria.

* must provide value

I DO NOT meet the criteria I meet the criteria

Do I have to participate?

No. You can choose to not participate or stop at any time.

Risks and Confidentiality

There are no physical risks involved in this study. Any time you participate in an online survey, there is a small risk to privacy. I would like to assure you that this risk is remote and every effort will be taken to protect your privacy. Your information will only be viewed by the project’s investigators. Also, we will not link your email information to the data collected in the online survey. You will never be identified by name or email address.

Costs

By entering this study and providing your email address, you will be entering a chance to win a $100 Amazon gift card. If you win, you will be notified via email.

By clicking on the below link, you are stating that you understand the study, its risks to you, and you are agreeing to participate.

Who should I contact if I have any questions?

Dr. Helen Genova (email: hgenova@kesslerfoundation.org)

DO YOU CONSENT TO PARTICIPATE IN THE STUDY?

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You can contact me about other studies you are doing in the future

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