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All Sites (Generic) Survey Mid of Study

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Participant Survey at Mid-Study

Experience during the trial:

Thank you from Revival Research Institute, LLC for being part of the clinical study. To create better experiences for you and other participants in this and future studies, we would like to know about your experiences in the study you are part of now. This survey should take less than 5 minutes to complete..

We will keep your responses anonymous. You do not need to answer all of the questions if you do not want to.

1. First, how satisfied are you with each aspect of the study? Please use a scale of 1 to 5, with 1 meaning that you are “very dissatisfied” and 5 meaning that you are “very satisfied.”(Required)
*Ease of scheduling study visits
*Wait time for study visits and procedures once I was in the office(Required)
*Comfort of waiting area(Required)
*Comfort of exam/procedure area(s)(Required)
*Private handling of my identity and information(Required)
*Parking(Required)
*Transportation options(Required)
*Payment provided to me(Required)
2. How do you feel about the study visits and procedures?
2a. How often you were required to come in for study visits:
2b. Number of procedures at each study visit:(Required)
2b. Number of procedures at each study visit:
2c. Length of study visits:(Required)
2c. Length of study visits:
2d. Number of diaries to complete:(Required)
2d. Number of diaries to complete:
2e. Instructions for how and when to take the study medication(s):(Required)
2e. Instructions for how and when to take the study medication(s):
2f. Were there any procedures that you did not like or found difficult?(Required)
2f. Were there any procedures that you did not like or found difficult?
3. Have we understood your needs as a patient in each area of the study? Please rate on a scale of 1 to 5 where 1 means “very poor understanding” and 5 means “excellent understanding.” You can also select “don’t know.”(Required)
Goals of the study
Study procedures(Required)
Study procedures
Study visit schedule(Required)
Study visit schedule
4. How do you feel about the Study Doctor(s) and Study Coordinator(s) you have been working with during the study, on each of the following? Please use a scale of 1 to 5, where 1 means that you are “very dissatisfied” and 5 means that you are “very satisfied.”

Skill/competence, no errors in my care

Study Doctor (S)(Required)
Study Coordinator (s)(Required)

Knows a lot about my condition

Study Doctor (S)(Required)
Study Coordinator (s)(Required)

Understands what it’s like to be somebody with my condition

Study Doctor (S)(Required)
Study Coordinator (s)(Required)

Explains things using words that I understand

Study Doctor (S)(Required)
Study Coordinator (s)(Required)

Easy to talk to/Friendly

Study Doctor (S)(Required)
Study Coordinator (s)(Required)

Encouraged questions

Study Doctor (S)(Required)
Study Coordinator (s)(Required)

Remembers my personal situation/history

Study Doctor (S)(Required)
Study Coordinator (s)(Required)

Pays attention to me/not in a rush

Study Doctor (S)(Required)
Study Coordinator (s)(Required)

Easy to reach/returns calls

Study Doctor (S)(Required)
Study Coordinator (s)(Required)

Concerned about my questions and worries/Caring

Study Doctor (S)(Required)
Study Coordinator (s)(Required)

Flexible to meet my needs

Study Doctor (S)(Required)
Study Coordinator (s)(Required)

Thoughtful and polite

Study Doctor (S)(Required)
Study Coordinator (s)(Required)

Honest/trustworthy

Study Doctor (S)(Required)
Study Coordinator (s)(Required)

Respectful

Study Doctor (S)(Required)
Study Coordinator (s)(Required)

Makes me feel confident about my medical care

Study Doctor (S)(Required)
Study Coordinator (s)(Required)

Treats me as a “whole person”

Study Doctor (S)(Required)
Study Coordinator (s)(Required)

Interested in how my condition affects my life

Study Doctor (S)(Required)
Study Coordinator (s)(Required)
4b. If you were to participate in another clinical trial, which five things about the study staff and site would be most important to you?(Required)
5. Have you experienced any of these during the trial so far? Please select all that apply.(Required)
6. How much has being in the study impacted your daily life so far?(Required)
8. If you are considering dropping out of the trial, can you tell us why? Please check all that apply(Required)
9. Overall, do you feel that you are benefiting from participating in this study?(Required)
10. Based on your experience in this study, how likely would you be to participate in another clinical study in the future? 0=Not at all likely; 10=Extremely likely(Required)
Not at all likely Extremely likely
11. How likely would you recommend to others that they participate in a clinical study? 0=Not at all likely; 10=Extremely likely(Required)
Not at all likely Extremely likely