INFORMED CONSENT DOCUMENT AGREEMENT TO BE IN A RESEARCH STUDY

Challenge/Study Title	Repeating Days of the Week
Challenge Coach (The Person in Charge of This Research Study)	Efforia Advanced Author
Sponsor	This study is made possible by your payment to join.
Challenge Cost	$0
Included Products & Services
Outcome Measures
Contact	help@efforia.com

Hello there, future participant! We're inviting you to join a research study on Efforia, all about 'Repeating Days of the Week'. This isn't your usual study, it's more of an adventure of discovery. But, before you jump on board, make sure you've got all your questions answered. If you're not sure about something, hold off on proceeding until you are.

The Purpose of This Study

This study aims to understand how repeating the days of the week impacts memory and cognition. We're curious about how this repetition affects your daily routines and mental health. The findings could provide insights into cognitive processes and potentially improve memory techniques. Ultimately, we hope to make your week a little bit more interesting!

Your Responsibilities as a Participant

If you love a good challenge, this study is for you! We're looking for participants who can commit to repeating the days of the week for a certain period. You'll need to keep track of any changes you notice in your memory, cognition, or daily routines. Lastly, you should be able to communicate your experiences effectively as your feedback is crucial to our research.

Your Rights as a Participant

Remember, your participation is completely voluntary. You can opt-out anytime you want, but remember, your join fee is non-refundable. We respect your decision and your rights as a participant.

How to Leave the Study

If you decide this study isn't for you, simply go to your Profile page, click “Your Challenges” and click “leave.” Please remember your join fee is not refundable. This payment is important to keep the study experience sound for other participants.

Risks and Benefits

Every study has its risks and benefits. In this case, the risks may include some mental discomfort from answering potentially uncomfortable questions. If at any point you feel overwhelmed, please seek help from a mental health professional or contact the National Suicide Prevention Hotline by dialing 988. On the brighter side, you might develop new cognitive strategies and improve your memory! Remember, we can't guarantee any specific benefits. And your insurance might not cover research-related injuries, so it's a good idea to check with them first.

What to do if you have an adverse event or medical emergency

If you experience any adverse event or medical emergency, please seek immediate medical attention. Once you've done that, let us know by emailing help@efforia.com.

Data Protections

We'll be collecting data throughout this study, including your feedback and responses. This data will be used to send you reminders and personalized reports. Rest assured, all data is securely stored and only accessible to those you've given specific approval. As part of this study, we encourage you to share your experiences with others in the community. You can adjust your communication preferences to suit your comfort level. Please review the Efforia Terms & Conditions and Privacy Policy.

If you have questions

If you have any questions, feel free to engage with the community or contact help@efforia.com.

California Experiential Research Subject’s Bill of Rights

As a participant in this study, you have the right to be informed of the nature and purpose of the experiment, the procedures to be used, the expected benefits, and potential risks. You have the right to withdraw your consent and discontinue participation at any time without penalty or loss of benefits.

HIPAA Waiver

By participating in this study, you agree to waive certain privacy rights as outlined in the Health Insurance Portability and Accountability Act (HIPAA). This waiver allows the research team to access, use, and disclose your health information for the purpose of this study.

1. Authorization and Consent for Diagnostic Testing

1. I voluntarily consent and authorize CWI Physician Partners P.C., a California professional corporation; CWI Physician Partners P.C., a Hawaii professional corporation; CWI Physician Partners P.C., a Georgia professional corporation; CWI Physician Partners P.C., a Kansas professional corporation; CWI Physician Partners P.C., an Oregon professional corporation; CWI Physician Partners P.C., a Nevada professional corporation, CWI Physician Partners P.C., a Rhode Island professional corporation; CWI Physician Partners P.C., an Oklahoma professional corporation, as applicable ("CWI") to review the collection, testing, and analysis for the purposes of a diagnostic screening test. I understand that there are risks and benefits associated with undergoing a diagnostic screening testing and there may be a potential for false positive or false negative test results. I assume complete and full responsibility to take appropriate action with regards to my test results. Should I have questions or concerns regarding my results, or a worsening of my condition, I shall promptly seek advice and treatment from an appropriate medical provider. I further acknowledge the following:
   1. I am the individual who will provide the sample for the Test(s) that I am requesting or I am the parent or legal guardian of a minor who is providing the sample for testing.
   2. I am at least eighteen (18) years of age or I am the parent or legal guardian of a minor who is providing the sample for testing.
   3. I have read and understand the information provided about the Test(s) that I have been provided on the website where I requested the Test.
   4. The information I have provided in connection with my request to CWI is correct to the best of my knowledge. I will not hold CWI or its employees or agents responsible for any errors or omissions that I may have made in providing such information.
   5. My health information and results may be shared with CWI employees and agents for the purpose of ordering, processing, and reporting my results.
   6. Medical Services provided by CWI are purely for diagnostic assistance purposes and do not create a physician-patient relationship, and do not constitute medical care or diagnosis or treatment of any condition, disease, or illness.
   7. I authorize CWI to contact me via text message to communicate with me regarding my test.

1. Patient Rights and Privacy Practices
   1. Notice of Privacy Practices and Patient Rights: CWI Notice of Privacy Practices describes how it may use and disclose your protected health information for other purposes that are permitted or required by law. To review a copy of CWI Notice of Privacy Practices, go to http://www.CynergyWellness.com.
   2. Disclosure to Government Authorities: I acknowledge and agree that my test results and associated information may be disclosed to appropriate county, state, federal, or other governmental and regulatory entities as may be permitted by law.

1. Release
   1. To the fullest extent permitted by law, I hereby release, discharge and hold harmless, CWI, including, without limitation, any its respective officers, directors, employees, representatives and agents from any and all claims, liability, and damages, of whatever kind or nature, arising out of or in connection with any act or omission relating to my diagnostic test or the disclosure of my test results.
   2. By selecting the ACKNOWLEDGEMENT during the registration process for diagnostic testing, I acknowledge and agree that I have read, understand, and agreed to the statements contained within this form. I have read the contents of this form in its entirety and voluntarily consent to proceed with these procedures.