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RE-GHUMRA Survey at Enrollment

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Participant Survey at End of Screening

Thank you from Revive Research Institute, Inc. for being part of the clinical study. We would like to get your thoughts about why you entered the clinical study, and about what you want out of it. This will allow us to create better participant experiences for both this study and future studies. This survey should take less than 5 minutes to complete.

We want to assure you that none of your responses will be linked to your name, email address, or any other identifying information. You do not need to answer all of the questions if you do not want to.

1. How did you find out about this clinical study? (Please select all that apply)*
2. Were you actively looking for the opportunity to participate in a clinical study?*
3. Did you consider any other clinical studies before deciding to participate in this one?*
4. Have you participated in a clinical study before?*

7. Please tell us how you felt about the Consent Form that you signed:

7a. Length*
7b. How easy was it to understand?*
7c. Are there any parts of the Consent Form that you would like to see changed?*
7d. Would it have helped if you could have seen parts of the Consent Form before coming in for your screening visit?*
8. How much contact (in person, or by phone or email/text) would you like to have with clinical study staff during the study?*
9. How does your family feel about your being in the study?*
12. How interested would you be in knowing the results of the study once all patients complete and data are available?*
13. How interested would you be in getting your own clinical information (e.g. lab results, X-rays, etc.) during or after the study?*
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Revive Research Institute, Inc.

28270 Franklin Road
Southfield, MI
48034

T: 248-564-1485
E: info@rev-research.com