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RE-MALIK Survey at Mid Study

    Participant Survey at Mid-Study

    Experience during the trial:

    Thank you from Revive Research Institute, Inc. 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.”

    2. How do you feel about the study visits and procedures?

    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.”

    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)

    Study Coordinator (s)

    Knows a lot about my condition

    Study Doctor (S)

    Study Coordinator (s)

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

    Study Doctor (S)

    Study Coordinator (s)

    Explains things using words that I understand

    Study Doctor (S)

    Study Coordinator (s)

    Easy to talk to/Friendly

    Study Doctor (S)

    Study Coordinator (s)

    Encouraged questions

    Study Doctor (S)

    Study Coordinator (s)

    Remembers my personal situation/history

    Study Doctor (S)

    Study Coordinator (s)

    Pays attention to me/not in a rush

    Study Doctor (S)

    Study Coordinator (s)

    Easy to reach/returns calls

    Study Doctor (S)

    Study Coordinator (s)

    Concerned about my questions and worries/Caring

    Study Doctor (S)

    Study Coordinator (s)

    Flexible to meet my needs

    Study Doctor (S)

    Study Coordinator (s)

    Thoughtful and polite

    Study Doctor (S)

    Study Coordinator (s)

    Honest/trustworthy

    Study Doctor (S)

    Study Coordinator (s)

    Respectful

    Study Doctor (S)

    Study Coordinator (s)

    Makes me feel confident about my medical care

    Study Doctor (S)

    Study Coordinator (s)

    Treats me as a “whole person”

    Study Doctor (S)

    Study Coordinator (s)

    Interested in how my condition affects my life

    Study Doctor (S)

    Study Coordinator (s)

    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

    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

    Not at all likely
    Extremely likely
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    Revive Research Institute, Inc.

    28270 Franklin Road
    Southfield, MI
    48034

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