Thank you for your interest in this study.

The HCMA is providing you an opportunity to learn more about a study being conducted for patients with non-obstructive hypertrophic cardiomyopathy.

We are offering this eligibility survey in partnership with IQVIA™, who is working under contract with a pharmaceutical company. The HCMA will maintain the eligibility survey results and share only the information that you, the participant, authorize within this survey.

You may exit the eligibility survey at any time without providing contact information. If you complete the eligibility survey and later change your mind about the authorization you have provided, you may call the HCMA office and provide your name and contact information and request to be removed.

Our number is 973-983-7429 and our email is pm@4hcm.org; you may speak with Ross Hadley, Project Manager.

The purpose of this research is to better understand, from your point of view, a few questionnaires that may be used by patients in clinical studies for
non-obstructive hypertrophic cardiomyopathy.

We will be asking you some questions to see if you are eligible to participate. If you meet the requirements for participation, you will be given an Informed Consent Form to complete.  The Informed Consent Form will provide you with details about how the study works and your rights as a study participant. Once confirmed as eligible to participate and after you give informed consent to participate in the study, you may be asked to take part in a 60- to 90-minute telephone interview.

Any information you provide to us as part of this eligibility questionnaire will be treated as confidential. It will be combined with feedback from others like yourself and will be stored in the
United States for a pre-specified amount of time (see below).

Your information will be kept secure at all times. Personal identifying information, such as names and locations, will be removed and your study data will not be shared with any other organization without your permission. Any personal information you provide as part of this eligibility questionnaire will be deleted five years after completion of the study.

This research is being conducted by IQVIA™.
You have the right to withdraw at any time.

For more information about your rights, please see our privacy notice, which is available at www.iqvia.com/about-us/privacy.

Question Title

* 1. Do you consent to the information above and wish to proceed to see if you meet the requirements for participation in this study?

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