Consent Form to Participate in the Research Study

Study Title: Engagement to Inform Adaptive Trial: How do People With Chronic Low Back Pain Weigh Risks and Benefits—Discrete Choice Experiments Measure Patient’s Outcome


This is a research study to learn patient’s preferences for the risks and benefits of functional and behavioral outcomes of chronic low back pain treatment. The study researcher Leslie Wilson, Ph.D. from the UCSF Departments of Medicine and Pharmacy will explain this study to you.

Research studies include only people who choose to take part. Please take your time to make your decision about participating, and discuss your decision with your family or friends if you wish. If you have any questions, you may ask the researchers.

You are being asked to take part in this study because you currently have chronic low back pain.


 

CONSENT

You have been given a copy of this consent form to keep.

PARTICIPATION IN RESEARCH IS VOLUNTARY. You have the right to decline to be in this study or to withdraw from it at any point without penalty or loss of benefits to which you are otherwise entitled.

Please provide participant’s ADDRESS to receive $20 compensation for completing our survey.

Address: ________________________________                                                                                                                            

Please include any additional CONTACT information if you are willing to be contacted again.

Email: ___________________________________

Phone: __________________________________