EoE-Survey Consent Form (giving us permission to collect your answers to this
questionnaire)
Introduction
Thank you for considering participating in our survey on eosinophilic esophagitis (EoE). Your
insights are invaluable in helping us understand the experiences of patients and caregivers. This
study is being conducted and funded by the Global Allergy and Airways Patient Platform
(GAAPP) US Research team Ruth Tal-Singer, PhD, is the Principal Investigator working in
collaboration with volunteer contributors from Member Organization Niessan Association of
Israel who lead and fund a similar survey developed for people living in Israel.
Participation Criteria:
Are you:
- 18 years old or older?
- A patient diagnosed with eosinophilic esophagitis, or a caregiver for a person who is
diagnosed with this condition?
If you meet these criteria, we invite you to participate in our research study!
Purpose of the Survey
This anonymous survey aims to gather information about living with and receiving treatment
for eosinophilic esophagitis. The insights gained will support educational programs designed to
enhance care for patients or caregivers like you.
Survey Details
- Duration: Approximately 15 minutes to complete.
- Participation: Your participation is voluntary. You can skip any questions you prefer not to
answer and may withdraw at any time.
Confidentiality Assurance
- No information is collected in the study that can identify you, it is an anonymous survey
- There are no known risks associated with participating in this study.
- While there are no direct benefits to you and you will not be paid for the survey, your
responses will help GAAPP and the Niessan Association create valuable educational materials
for patients and healthcare providers.
- Your participation is free of charge, and your responses will remain anonymous; no personal
identifying information will be collected.
- Your information collected as part of this research study will be used for the purpose of
developing educational materials and may be integrated with information gathered from other
global research studies.
Questions
If you have any questions about this study, you may contact the research study team at
Research@GAAPP.org
If you reside in the US and have any questions concerning your rights as a research participant, you may contact the
Biomedical Research Alliance of New York Institutional Review Board at +1-(516) 318-6877 or
https://www.brany.com/concerns-about-research.
Your voice matters!
By clicking the link below, you consent to participate in this survey.
Click NEXT to start the survey:
