What You Need to Know to Participate
This document provides information to help you decide whether to join this research study. It is important you understand the responsibilities, risks and benefits of participating.
INFORMED CONSENT DOCUMENT AGREEMENT TO BE IN A RESEARCH STUDY
| Challenge/Study Title | Timing Test |
|---|---|
| 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 |
The Purpose of This Study
We are asking you to join a research study on Efforia (the "Timing Test"). This study is designed to help us understand how time perception affects decision making. The goal is to find out if our perception of time can be manipulated to improve our decision-making skills. Your participation will help us reveal more about this interesting aspect of human cognition!Your Responsibilities as a Participant
This study is suitable for adults who can make decisions independently and have some flexibility in their schedule. You will be asked to complete a series of tasks and questionnaires. Your participation will require you to be honest, punctual, and persistent. Remember, your input is essential for the success of this study!Your Rights as a Participant
Your participation in this study is entirely voluntary, and you may drop out at any time. However, please note that refunds are not available. We respect your autonomy and your decision to participate or not. We are committed to ensuring your rights and welfare are protected throughout the study.How to Leave the Study
To leave the study, 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
Participating in this study may bring up uncomfortable emotions or thoughts as you answer our questions. If you feel uncomfortable, we encourage you to seek the advice of an appropriate expert, like a doctor, or life coach. If at any time you feel suicidal, please contact the National Suicide Prevention Hotline by dialing 988. This study does not provide a medical diagnosis or cure and some insurance plans may not pay for research-related injuries. You may not directly benefit from participating in this study, but you will receive assessments and test results.What to do if you have an adverse event or medical emergency
Contact your local personal medical care provider immediately. Do not attempt to contact Efforia, the community, or study sponsors until after you’ve sought care. Once you’ve sought care, report any adverse events to help@efforia.com.Data Protections
We will collect data related to your participation in the study. The data will be used to provide reminders, personalized outcome reports, and overall findings. Your data is stored on secure servers and can only be accessed by those you've given specific approval to. You can adjust your communication preferences in your Efforia profile. Please review the Efforia Terms & Conditions and Privacy Policy.If you have questions
If you have questions, engage with the community - that’s what it's there for! If you prefer private communications, please contact help@efforia.com.California Experiential Research Subject’s Bill of Rights
Under the California Experiential Research Subject’s Bill of Rights, you have the right to be informed about the nature and purpose of the experiment; to be given an explanation of the procedures to be followed in the medical experiment, and any drug or device to be used; to be given a description of any attendant discomforts and risks to be reasonably expected; to be told of benefits to be expected; and to be given other facts about the study.HIPAA Waiver
By participating in this study, you are waiving certain privacy rights under the Health Insurance Portability and Accountability Act (HIPAA). This does not mean that your private health information will be shared indiscriminately. Rather, it means that the health information you provide as part of this study may be used to support the research objectives.- Authorization and Consent for Diagnostic Testing
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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:
- 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.
- 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.
- 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.
- 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.
- My health information and results may be shared with CWI employees and agents for the purpose of ordering, processing, and reporting my results.
- 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.
- I authorize CWI to contact me via text message to communicate with me regarding my test.
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Patient Rights and Privacy Practices
- 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.
- 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.
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Release
- 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.
- 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.