Trauma

 

By taking a few minutes to complete this form, your responses will be included in information used to determine if or how this study will be conducted. Your input is important to us, and will aid us in our future decisions regarding this study.

If you have not yet viewed the Vasopressin study presentation:

Click HERE for web presentation
(requires no additional software besides your web browser)

Step 4: Low Dose Vasopressin Study - Questionnaire

Please answer ALL questions - if you have no response for any of the questions, please type in 'no response' or 'N/A'. If any questions are left blank, it will cause an error and won't send the information.

1. Do you live in Texas? Yes   No

2. If   NO, you do not live in Texas, please click here to exit and discontinue questionnaire.

If   YES, you DO live in Texas, which county do you live in?    

3. Did the presentation help you to understand what this study is about?

Yes   No

4. In your own words, describe the purpose of this study and how it will be conducted, as you understand it:

5. Patients enrolled in this study will not be giving their informed consent before they become participants. Instead, your community is assisting in the approval of this study.

Do you understand the reasons for this? Yes   No

6. Do you object to the enrollment of someone in this research study without his or her individual consent before the study begins? Yes   No

7. Do you feel it is acceptable to conduct the study? Yes   No

Why or why not?

Gender (check one):   Male     Female

 

The following section is optional - responses are NOT required.
Please enter N/A in each field if you do not wish to respond with your information.

Age:

Ethnic background:

 

Click here to review your information before sending

    

 

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Principal Investigator: Stephen M. Cohn, MD, UTHSCSA Department of Surgery, 7703 Floyd Curl Drive, San Antonio, TX 78229-3900. Questions or comments? Phone 210-567-3623 or email Vasopressin Study.
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