Consent for Participation in Research
Approval Date: August 5, 2019
Identification and Purpose of the Study
You are invited to participate in a research study, entitled “Psychedelics and Wellness Study (PAWS): An online anonymous survey investigating the interrelationship between psychedelics and wellness.” The study is being conducted by co-Principal Investigators: 1) Dr. Saundra Jain, Adjunct Clinical Affiliate, School of Nursing at The University of Texas at Austin, Austin, TX, drjain@wild5wellness.com and 2) Dr. Rakesh Jain, Clinical Professor, Department of Psychiatry, School of Medicine at Texas Tech University, Midland, Texas, jaintexas@gmail.com.
The purpose of this consent form is to provide you with information that may affect your decision about participating in this research study. To participate, you must be at least 18+ years old and have taken a psychedelic at least once.
A description of this study will be available on http://www.ClinicalTrials.gov as required by U.S. Law. This web site will not include information that can identify you, and at most, will only include a summary of the results of this study.
What will you be asked to do?
If you agree to participate, you will be asked to complete an online anonymous survey, which takes about 8-minutes to complete. The study expects to include approximately 5,000 survey respondents.
What are the risks involved in this study?
Potential risks are minimal.
What are the possible benefits of this study?
Participants may benefit by aiding in the advancement of research regarding the intersect between psychedelics and wellness.
Do you have to participate?
No, your participation is voluntary.
Will there be any compensation?
You will not receive any type of payment.
How will your privacy and confidentiality be protected if you participate in this research study?
Your privacy and the confidentiality of your data will be protected. All data will be captured online and stored on secure online servers. All information and data will be destroyed three years after study approval.
The data resulting from your participation may be made available to other researchers in the future for research purposes not detailed within this consent form. In these cases, the data will contain no identifying information that could associate it with you, or with your participation in this study.
Whom to contact with questions concerning your rights as a research participant?
For questions about your rights or any dissatisfaction with any part of this study, you can contact, anonymously if you wish, the Western Institutional Review Board by phone at (800) 562-4789 or email at clientservices@wirb.com.
Participation Agreement
You have been informed about this study’s purpose, procedures, possible benefits and risks. You voluntarily agree to participate in this study. By agreeing to participate, you are not waiving any of your legal rights.
Mental Health Resources
Participation in this study does not imply any type of professional relationship with the researchers. If you are in crisis, please contact your healthcare provider or refer to the list of resources of below:
Identification and Purpose of the Study
You are invited to participate in a research study, entitled “Psychedelics and Wellness Study (PAWS): An online anonymous survey investigating the interrelationship between psychedelics and wellness.” The study is being conducted by co-Principal Investigators: 1) Dr. Saundra Jain, Adjunct Clinical Affiliate, School of Nursing at The University of Texas at Austin, Austin, TX, drjain@wild5wellness.com and 2) Dr. Rakesh Jain, Clinical Professor, Department of Psychiatry, School of Medicine at Texas Tech University, Midland, Texas, jaintexas@gmail.com.
The purpose of this consent form is to provide you with information that may affect your decision about participating in this research study. To participate, you must be at least 18+ years old and have taken a psychedelic at least once.
A description of this study will be available on http://www.ClinicalTrials.gov as required by U.S. Law. This web site will not include information that can identify you, and at most, will only include a summary of the results of this study.
What will you be asked to do?
If you agree to participate, you will be asked to complete an online anonymous survey, which takes about 8-minutes to complete. The study expects to include approximately 5,000 survey respondents.
What are the risks involved in this study?
Potential risks are minimal.
What are the possible benefits of this study?
Participants may benefit by aiding in the advancement of research regarding the intersect between psychedelics and wellness.
Do you have to participate?
No, your participation is voluntary.
Will there be any compensation?
You will not receive any type of payment.
How will your privacy and confidentiality be protected if you participate in this research study?
Your privacy and the confidentiality of your data will be protected. All data will be captured online and stored on secure online servers. All information and data will be destroyed three years after study approval.
The data resulting from your participation may be made available to other researchers in the future for research purposes not detailed within this consent form. In these cases, the data will contain no identifying information that could associate it with you, or with your participation in this study.
Whom to contact with questions concerning your rights as a research participant?
For questions about your rights or any dissatisfaction with any part of this study, you can contact, anonymously if you wish, the Western Institutional Review Board by phone at (800) 562-4789 or email at clientservices@wirb.com.
Participation Agreement
You have been informed about this study’s purpose, procedures, possible benefits and risks. You voluntarily agree to participate in this study. By agreeing to participate, you are not waiving any of your legal rights.
Mental Health Resources
Participation in this study does not imply any type of professional relationship with the researchers. If you are in crisis, please contact your healthcare provider or refer to the list of resources of below:
- National Suicide Prevention Lifeline – 800.273.TALK (8255). This is a 24-hour, toll-free, confidential suicide prevention hotline available to anyone in suicidal crisis or emotional distress.
- Crisis Text Line – 741741 (Text “HOME”). This is a 24-hour, free, support of persons in any type of crisis, including suicidal ideation, via text medium. https://www.crisistextline.org/texting-in
- SAMHSA (Substance Abuse and Mental Health Services Administration) National Helpline – 800.662.HELP (4357). This is a free, confidential, 24/7, 365-day-a-year treatment referral and information service (in English and Spanish) for individuals and families facing mental health and/or substance use disorders.
- 911 - This number is intended for use in emergency circumstances only.