Medical Research Consent

Prenatal Genetic Screening (PGS) Research Study

HIPAA Compliance
Study Information & Consent
Please review the following information about this research study

What is this study about?

You are being asked to participate in a research study to evaluate tools that provide information on prenatal genetic screening (PGS). If you agree to participate, you will be asked to review a web-based tool to better understand PGS and your screening preferences. After you have viewed the tool, you will be invited to complete a survey to provide us feedback about your experience. You may also be invited to take part in a brief phone survey to share additional information with the study team.

What information will be collected?

You will be asked to enter some demographic information into the web tool including your name, date of birth, phone number and email address. Your personal information and all of your interactions with the tool will be kept confidential.

How is my privacy protected?

This research is covered by a Certificate of Confidentiality from the National Institutes of Health(NIH). This means that the researchers cannot release or use information, documents, or samples that may identify you in any action or lawsuit unless you say it is okay. They also cannot provide them as evidence unless you have agreed. This protection includes federal, state, or local civil, criminal, administrative, legislative, or other proceedings. An example would be a court subpoena.

Your participation is voluntary

Please understand your participation is voluntary and you have the right to withdraw your consent or discontinue participation at any time without penalty. Any current or future medical care will not be jeopardized if you choose not to participate.

Patient Information
Please provide your contact information for this research study
Consent Agreements
Please confirm that your agree to participate by checking all required items

I have read about the purpose, risks, and benefits of participating in this research study.

I can leave the study at any time without affecting my medical care.

I consent to the collection and use of my information for this research.

By clicking this button, you are providing your electronic signature and agreeing to participate in this research study. You will be redirected to the screening tool to begin your participation.

Questions about this study? Contact: [Principal Investigator Name and Phone/Email]
Questions about your rights as a research participant? Contact our Institutional Review Board at [IRB Phone/Email]