Diabetic patient awareness of symptoms and complications
Informed consent for anonymous survey
You are invited to participate in a research study titled “Awareness of myocardial infarction symptoms in diabetic population”.
This study is being conducted by:
Principal Investigator: Lise Johnson, PhD
Co Investigator: Jeremy Petzold, PA-S
The purpose of this study is to assess the awareness among patients with diabetes of heart attack symptoms .
Participation in this study is entirely voluntary at all times. You can choose not to participate at all or to leave the study at any point. If you decide not to participate, or to leave the study, there will be no penalty or loss of benefits to which you are entitled, or any effect on your relationship with the researcher(s), or any other negative consequences.
You are being asked to take part in this study because you have a medical diagnosis of diabetes, any type.
If you agree to participate, you will be asked to fill out a survey containing questions that will assess your medical knowledge of symptoms of an MI and other risks associated with diabetes. This survey should take around 5 minutes to complete.
The survey will be collected on Google Forms.
All of your responses to this survey will remain anonymous and cannot be linked to you in any way. No personally identifying information about you will be collected at any point during the study, and your survey will be identified only with a random number. You are free to withdraw from this study at any time. However, once you submit your completed survey, there will be no way to withdraw your responses from the study because the survey contains no identifying information.
Study data will be kept in digital format on a secure laptop. Access to digital data will be password protected. Only investigators of this study will have access to the data.
Any risks to you associated with this study are not expected to be greater than anything you encounter in everyday life. While you will not experience any direct benefits from participation, information collected in this study may benefit others in the future by helping to identify trends in awareness and increase that awareness through education.
If you have any questions regarding the survey or this research project in general, please contact the co investigator, Jeremy Petzold, at (989) 550- 1003 or the faculty mentor, Lise Johnson, at
If you have any questions about your rights as a research participant, please contact the Rocky Vista University IRB Compliance Administrator at 720-874-2481 or
By completing and submitting this survey, you are indicating your consent to participate in this study.
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google.
Terms of Service