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Consent
Patient Reported Outcome Measure Survey




You are invited to participate in a research study to evaluate patient’s perspectives on their ability to make informed healthcare decisions and their interactions with their healthcare providers.  This study is being conducted by the AHA/ASA.

You will be asked to complete an online survey about how you perceive your ability to manage your health and healthcare decision making. You will also be asked some basic question about you and your health.  This study will take no longer than 6-8 minutes.


Your decision to participate or decline participation in this study is completely voluntary and you have the right to terminate your participation at any time without penalty. You may skip any questions you do not wish to answer.

Your participation in this research will be completely confidential. Any report of this research that is made available to the public will not include your name or any other individual information by which you could be identified. We may present results at scientific meetings and publish results in professional journals. Although your participation in this research may not benefit you personally, it will help us understand patient and provider relationships and how to develop programs to support patients in their healthcare journeys.

There are no risks to individuals participating in this survey beyond those that exist in daily life.

If you have questions about this project, you may contact Amber Hoover at ChangeCholesterol@heart.Org and/or at supportnetwork@heart.org.

If you have any questions about your rights as a participant in this study or any concerns or complaints, please contact the Chesapeake Institutional Review Board at 410-884-2900.

Please feel free to print a copy of this consent page to keep for your records. 

I have read and understand the above consent form, I certify that I am 18 years old or older and, by clicking the submit button to enter the survey, I indicate my willingness voluntarily to take part in the study.