{"id":1262,"date":"2020-06-17T16:25:03","date_gmt":"2020-06-17T21:25:03","guid":{"rendered":"https:\/\/uwm.edu\/pahrlab\/?page_id=1262"},"modified":"2026-03-03T11:52:22","modified_gmt":"2026-03-03T17:52:22","slug":"informed-consent","status":"publish","type":"page","link":"https:\/\/uwm.edu\/pahrlab\/research\/informed-consent\/","title":{"rendered":"Participant Registry Informed Consent"},"content":{"rendered":"\n<p><strong><em>If you would like to be a participant in our registry, please read the informed consent below or download a PDF of the form.<\/em><\/strong><\/p>\n\n\n\n<div class=\"uwm-u-flex uwm-u-flex--left\">\n<a class=\"uwm-c-button uwm-u-mr-20 uwm-u-mb-20\" href=\"https:\/\/uwm.edu\/pahrlab\/wp-content\/uploads\/sites\/267\/2020\/12\/AppendixA_OnlineConsentR3.pdf\" rel=\"\">Download Informed Consent Form (PDF)<\/a>\n<\/div>\n\n\n\n<h2 class=\"wp-block-heading\" id=\"h-university-of-wisconsin-milwaukee-consent-to-participate-in-online-survey-research\">University of Wisconsin \u2013 Milwaukee<br>Consent to Participate in Online Survey Research<\/h2>\n\n\n\n<h3 class=\"wp-block-heading\" id=\"h-study-title\">Study Title<\/h3>\n\n\n\n<p>Research Participant Registry<\/p>\n\n\n\n<h3 class=\"wp-block-heading\" id=\"h-person-responsible-for-research-principle-investigator-pi\">Person Responsible for Research (Principle Investigator (PI))<\/h3>\n\n\n\n<p>Dr. Scott Strath, PhD<br>Director<br>Physical Activity and Health Research Laboratory<br>College of Health Sciences<\/p>\n\n\n\n<h3 class=\"wp-block-heading\" id=\"h-study-description\">Study Description<\/h3>\n\n\n\n<p>The purpose of this study is to create and maintain a research participant database of those individuals who are interested in learning about and potentially participating in future studies being conducted by scientists affiliated with the Physical Activity and Health Research Laboratory. This study is being conducted at the University of Wisconsin-Milwaukee. Five thousand people (ages 18-90+ years) will become part of this participant database.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\" id=\"h-study-procedures\">Study Procedures<\/h3>\n\n\n\n<h4 class=\"wp-block-heading\" id=\"h-what-will-i-be-asked-to-do-if-i-participate-in-the-study\"><strong>What will I be asked to do if I participate in the study?<\/strong><\/h4>\n\n\n\n<p>If you agree to participate, you will be asked to:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Read and sign this informed consent document allowing us to contact you at a future date to inform you of new research opportunities\/protocols.<\/li>\n\n\n\n<li>Provide us with your name, address, phone number, and\/or email address, which will be stored in a secure, password protected electronic database.<\/li>\n\n\n\n<li>Complete a short enrollment questionnaire containing 18 questions about your health status and caregiver status. The questions will be used for screening for whether you are eligible to participate in future studies.<\/li>\n<\/ul>\n\n\n\n<h4 class=\"wp-block-heading\" id=\"h-what-happens-after-i-enroll-in-the-participant-registry\"><strong>What happens after I enroll in the participant registry?<\/strong><\/h4>\n\n\n\n<ul class=\"wp-block-list\">\n<li>When a researcher is starting a new study, they will request permission to find out if any individuals in the participant registry database are eligible to participate in the new study.<\/li>\n\n\n\n<li>The criteria for study eligibility will be reviewed and used to create a list of individuals from the participant registry database who may be eligible. That list will then be shared with the researcher who is starting the study.<\/li>\n\n\n\n<li>A member of the study team, such as a research assistant, will contact the individuals on the list to see if they would like to participate in the new study.<\/li>\n\n\n\n<li>If you are contacted about participating in a new study, you can decide whether or not you would like to be part of the study.\n<ul class=\"wp-block-list\">\n<li>If you want to be part of the new study, a member of the study team will explain the study and everything that you would have to do to be part of the study.<\/li>\n\n\n\n<li>If you do not want to be part of the new study, you can say that you do not want to be in the study, and you will not be contacted again about that study.<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n\n\n\n<h3 class=\"wp-block-heading\" id=\"h-risks-benefits\">Risks\/Benefits<\/h3>\n\n\n\n<p>Risks to participants are considered minimal. Collection of data and survey responses using the internet involves the same risks that a person would encounter in everyday use of the internet, such as breach of confidentiality. While the researchers have taken every reasonable step to protect your confidentiality, there is always the possibility of interception or hacking of the data by third parties that is not under the control of the research team.<\/p>\n\n\n\n<p>There will be no costs for participating. There are no benefits to you other than to further research.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\" id=\"h-limits-to-confidentiality\">Limits to Confidentiality<\/h3>\n\n\n\n<p>Identifying information such as your name, address, phone number, and email address will be collected to add to our participant registry database so that you can be contacted about studies you may want to participate in in the future. Data will be retained on the Qualtrics website server for up to three months and will be deleted after this time. However, data may exist on backups or server logs beyond the timeframe of this research project. Data transferred from the survey site will be saved in an encrypted format for as long as you remain active in the participant registry database. Only the PI, Co-Investigator and authorized lab research personnel (such as student research assistants) will have access to the data collected by this study. If you qualify for a new study, the researcher(s) conducting the study will have access to your contact information. However, the Institutional Review Board at UW-Milwaukee or appropriate federal agencies like the Office for Human Research Protections may review this study\u2019s records.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\" id=\"h-voluntary-participation\">Voluntary Participation<\/h3>\n\n\n\n<p>Your participation in this study is voluntary. You may choose to not answer any of the questions or withdraw from this study at any time without penalty. Your decision will not change any present or future relationship with the University of Wisconsin Milwaukee.<\/p>\n\n\n\n<p>If you decide to enroll in the participant registry now, and later decide that you do not want to be contacted regarding future studies, we will remove you from the registry and you will not be contacted about any additional future studies. If you would like to be removed from the registry, please email&nbsp;<a href=\"mailto:research-registry@uwm.edu\">research-registry@uwm.edu<\/a>&nbsp;with the subject line \u201cRemove From Registry\u201d and include in the body of the email your name and phone number so that we can remove the correct record from the database. Alternatively, you may call the lab at 414-229-7319 and ask to be removed from the registry. The person who answers the phone will ask for your name and phone number so that we can remove the correct record from the database.<\/p>\n\n\n\n<p>In addition, you have the right to refuse to participate in any future study, but still remain part of the participant registry database to be contacted about other studies. If you do not want to participate in a study, you can inform the person who contacts you that you do not want to be part of that study.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\" id=\"h-who-do-i-contact-for-questions-about-the-study\">Who do I contact for questions about the study?<\/h3>\n\n\n\n<p>For more information about the study or study procedures, contact:<\/p>\n\n\n\n<p>Dr. Scott Strath, PhD<br>Director<br>Physical Activity and Health Research Laboratory<br><a href=\"mailto:research-registry@uwm.edu\">research-registry@uwm.edu<\/a><br><a href=\"tel:414-229-3666\">414-229-3666<\/a><\/p>\n\n\n\n<h3 class=\"wp-block-heading\" id=\"h-who-do-i-contact-for-questions-about-my-rights-or-complaints-towards-my-treatment-as-a-research-subject\">Who do I contact for questions about my rights or complaints towards my treatment as a research subject?<\/h3>\n\n\n\n<p>Contact the 51ÁÔÆæ IRB at <a href=\"tel:414-662-3544\">414-662-3544<\/a> or&nbsp;<a href=\"mailto:irbinfo@uwm.edu\">irbinfo@uwm.edu<\/a><\/p>\n\n\n\n<h3 class=\"wp-block-heading\" id=\"h-research-subject-s-consent-to-participate-in-research\">Research Subject\u2019s Consent to Participate in Research<\/h3>\n\n\n\n<p>By entering this survey, you are indicating that you have read the consent form, you are age 18 or older and that you voluntarily agree to participate in this research study.<\/p>\n\n\n\n<p>Thank you!<\/p>\n\n\n<script type=\"text\/javascript\">\n\/* <![CDATA[ *\/\nvar gform;gform||(document.addEventListener(\"gform_main_scripts_loaded\",function(){gform.scriptsLoaded=!0}),document.addEventListener(\"gform\/theme\/scripts_loaded\",function(){gform.themeScriptsLoaded=!0}),window.addEventListener(\"DOMContentLoaded\",function(){gform.domLoaded=!0}),gform={domLoaded:!1,scriptsLoaded:!1,themeScriptsLoaded:!1,isFormEditor:()=>\"function\"==typeof 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card-form_wrapper registry_wrapper' data-form-theme='gravity-theme' data-form-index='0' id='gform_wrapper_4' style='display:none'>\n                        <div class='gform_heading'>\n\t\t\t\t\t\t\t<p class='gform_required_legend'>&quot;<span class=\"gfield_required gfield_required_asterisk\">*<\/span>&quot; indicates required fields<\/p>\n                        <\/div><form method='post' enctype='multipart\/form-data'  id='gform_4' class='card-form registry' action='\/pahrlab\/wp-json\/wp\/v2\/pages\/1262' data-formid='4' novalidate><div class='gf_invisible ginput_recaptchav3' data-sitekey='6Let4LkmAAAAAMDytJZITec55NB97k2BiShMXqPE' data-tabindex='0'><input id=\"input_35be03f21148cf7daf00d9edcddf7231\" class=\"gfield_recaptcha_response\" type=\"hidden\" name=\"input_35be03f21148cf7daf00d9edcddf7231\" value=\"\"\/><\/div>\n                        <div class='gform-body gform_body'><div id='gform_fields_4' class='gform_fields top_label form_sublabel_below description_below validation_below'><fieldset id=\"field_4_1\" class=\"gfield gfield--type-radio gfield--type-choice gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Would you like to participate in the Participant Registry?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_4_1'>\n\t\t\t<div class='gchoice gchoice_4_1_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_1' type='radio' value='I want to participate'  id='choice_4_1_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_4_1_0' id='label_4_1_0' class='gform-field-label gform-field-label--type-inline'>I want to participate<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_4_1_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_1' type='radio' value='I DO NOT want to participate'  id='choice_4_1_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_4_1_1' id='label_4_1_1' class='gform-field-label gform-field-label--type-inline'>I DO NOT want to participate<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_4_2\" class=\"gfield gfield--type-name first-field gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Name<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_complex ginput_container ginput_container--name no_prefix has_first_name no_middle_name has_last_name no_suffix gf_name_has_2 ginput_container_name gform-grid-row' id='input_4_2'>\n                            \n                            <span id='input_4_2_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_2.3' id='input_4_2_3' value=''   aria-required='true'     \/>\n                                                    <label for='input_4_2_3' class='gform-field-label gform-field-label--type-sub '>First<\/label>\n                                                <\/span>\n                            \n                            <span id='input_4_2_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_2.6' id='input_4_2_6' value=''   aria-required='true'     \/>\n                                                    <label for='input_4_2_6' class='gform-field-label gform-field-label--type-sub '>Last<\/label>\n                                                <\/span>\n                            \n                        <\/div><\/fieldset><fieldset id=\"field_4_3\" class=\"gfield gfield--type-address field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Address<\/legend>    \n                    <div class='ginput_complex ginput_container has_street has_street2 has_city has_state has_zip ginput_container_address gform-grid-row' id='input_4_3' >\n                         <span class='ginput_full address_line_1 ginput_address_line_1 gform-grid-col' id='input_4_3_1_container' >\n                                        <input type='text' name='input_3.1' id='input_4_3_1' value=''    aria-required='false'    \/>\n                                        <label for='input_4_3_1' id='input_4_3_1_label' class='gform-field-label gform-field-label--type-sub '>Street Address<\/label>\n                                    <\/span><span 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                         <input type='text' name='input_3.4' id='input_4_3_4' value=''      aria-required='false'    \/>\n                                        <label for='input_4_3_4' id='input_4_3_4_label' class='gform-field-label gform-field-label--type-sub '>State \/ Province \/ Region<\/label>\n                                      <\/span><span class='ginput_left address_zip ginput_address_zip gform-grid-col' id='input_4_3_5_container' >\n                                    <input type='text' name='input_3.5' id='input_4_3_5' value=''    aria-required='false'    \/>\n                                    <label for='input_4_3_5' id='input_4_3_5_label' class='gform-field-label gform-field-label--type-sub '>ZIP \/ Postal Code<\/label>\n                                <\/span><input type='hidden' class='gform_hidden' name='input_3.6' id='input_4_3_6' value='' \/>\n                    <div class='gf_clear gf_clear_complex'><\/div>\n                <\/div><\/fieldset><div id=\"field_4_4\" class=\"gfield gfield--type-email field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_4_4'>Email<\/label><div class='ginput_container ginput_container_email'>\n                            <input name='input_4' id='input_4_4' type='email' value='' class='large'     aria-invalid=\"false\"  \/>\n                        <\/div><\/div><div id=\"field_4_5\" class=\"gfield gfield--type-phone field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_4_5'>Cell Phone<\/label><div class='ginput_container ginput_container_phone'><input name='input_5' id='input_4_5' type='tel' value='' class='large'    aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_4_6\" class=\"gfield gfield--type-phone field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_4_6'>Home Phone<\/label><div class='ginput_container ginput_container_phone'><input name='input_6' id='input_4_6' type='tel' value='' class='large'    aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_4_8\" class=\"gfield gfield--type-consent gfield--type-choice gfield--input-type-consent gfield_contains_required field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Informed Consent<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_consent'><input name='input_8.1' id='input_4_8_1' type='checkbox' value='1'  aria-describedby=\"gfield_consent_description_4_8\" aria-required=\"true\" aria-invalid=\"false\"   \/> <label class=\"gform-field-label gform-field-label--type-inline gfield_consent_label\" for='input_4_8_1' >I voluntarily agree to participate in this registry<\/label><input type='hidden' name='input_8.2' value='I voluntarily agree to participate in this registry' class='gform_hidden' \/><input type='hidden' name='input_8.3' value='1' class='gform_hidden' \/><\/div><div class='gfield_description gfield_consent_description' id='gfield_consent_description_4_8' tabindex='0'>By hitting submit, you are indicating that you have read the consent form, you are age 18 or older and that you voluntarily agree to participate in this research study.<\/div><\/fieldset><div id=\"field_4_13\" class=\"gfield gfield--type-html gfield_html gfield_html_formatted field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><p>Thank you for considering participating in our registry! 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