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Wyoming Telehealth Network

Telehealth Provider Questionnaire

Informed Consent

Informed Consent

Identification of Project: This study will investigate opportunities and challenges to implementing telehealth services in Wyoming. 

Project Description: The purpose of this research is to assess current practices and attitudes regarding telehealth services and barriers that may prevent  providers from implementing telehealth services to their patients in the state of Wyoming. This survey will ask you to complete a few demographic questions and questions regarding your opinion of telehealth services. The survey should take approximately 3-5 minutes to complete. Upon completion, you will be given an option to enter your contact information for a chance to win one of three $150 gift cards.

Risks: Participation in this study involves minimal risks. The current study involves no more risk than a person would experience anytime they answer questions about their practice or use the internet.

Benefits: If you choose, you may be entered into a drawing for a chance to win one of three $150 gift cards.

Confidentiality: Your responses will not be linked to your personal information, thus your response will remain anonymous. Further, if you provide contact information for the gift card raffle, this information will be kept confidential and will not be linked to your responses on the survey in any way. We are interested in general trends across providers in Wyoming, not in individual responses. Only the researchers will have access to the data. The aggregated data will be used for educational I knopresentations and publications, and the raw data will be stored on a password-protected external hard drive for at least three years.

Contact Person: Any questions that you may have concerning this research before, during, or after completion of the survey should be directed to the primary researcher, Canyon Hardesty, Wyoming Institute for Disabilities, at canyon@uwyo.edu. If you have questions about your rights as a research participant, please contact the University of Wyoming IRB administrator at (307) 766-5320.

Freedom to Withdraw: Your participation in this study is completely voluntary. You are free to withdraw your consent at any time, without penalty. If you agree to participate, you can still withdraw from this research at any time by ceasing to answer questions or navigating away from the survey website.

Consent: You are voluntarily making a decision whether or not to participate in this research study. If you think of any questions during this survey, please contact the primary investigator (canyon@uwyo.edu).

1. By selecting “Yes” below, you are acknowledging that you have read and understand the above statements and agree to participate in the study.
  *This question is required.