CONSENT FORM

You are invited to take part in a research study of Clinical research participants. You were chosen for the study because you indicated that you have participated in a clinical trial. This form is part of a process called “informed consent” to allow you to understand this study before deciding whether to take part.

This study is being conducted by a researcher Carrie M. Lee MBA, who is a doctoral student at Walden University.

Background Information:

The purpose of this study is to determine if some people join clinical trials to receive access to healthcare.

Procedures:

If you agree to be in this study, you will be asked to:

• Take a brief web survey with an estimated duration of 10 minutes.

Voluntary Nature of the Study:

Your participation in this study is voluntary. This means that everyone will respect your decision of whether or not you want to be in the study. No one who has provided care to you at your clinical research center will treat you differently if you decide not to be in the study. If you decide to join the study now, you can still change your mind during the study. If you feel stressed during the study you may stop at any time. This work will help researchers better understand the relationship between participation in clinical trials and access to health care.

Risks and Benefits of Being in the Study:

There are no perceived risks to participation in this study. No personal or identifying data is collected on participants and all responses are anonymous.

Compensation:

No compensation is provided for participation in this survey.

Confidentiality:

All answers to this survey are anonymous. Any information you provide will be kept by the researcher. The researcher will not use your information for any purposes outside of this research project. Also, the researcher will not include your name or anything else that could identify you in any reports of the study.

Contacts and Questions:

You may ask any questions you have now. Or if you have questions later, you may contact the researcher via carrie.lee@waldenu.edu. If you want to talk privately about your rights as a participant, you can call Dr. Leilani Endicott. She is the Walden University representative who can discuss this with you. Her phone number is 1-800-925-3368, extension 1210. Walden University’s approval number for this study is 03-18-10-0363696 and it expires on March 17, 2011.

The researcher will give you a copy of this form to keep upon request.

Statement of Consent:

I have read the above information and I feel I understand the study well enough to make a decision about my involvement. By continuing in this survey, I am agreeing to the terms described above.