Neuroendocrine Tumor Registry Consent Screening Form

The purpose of this online screening is to see if you meet the criteria for taking part in our research study of Neuroendocrine tumors. Another purpose is to see if you want to hear about other research studies that will be done in the future; we are keeping a database of contact information to use for such future research purposes

This screening will take approximately 5 minutes. You are going to be shown a series of questions. You may choose not to answer these questions. You also may choose to stop participating in this screening at any time.

Information about you that you will provide during this online screening will be kept as confidential as possible as required by law. It is possible that the Food and Drug Administration, and other federal and state authorities, may inspect this record.

You can choose if you want or do not want to take part in this research screening procedure – it is up to you. If you refuse to answer the questions or stop answering them at any time, there will be no penalty, and you will not lose any benefits to which you otherwise would be entitled.

The risk to taking part in this interview is very small. The screening interview is not designed to ask you for sensitive personal information, but it is possible that some people may feel uncomfortable answering these questions online. If you qualify to take part in the study and are interested in taking part in it or in future studies, then your name and information will be recorded; this will be kept confidential, but there is a small risk that people outside of the Gastrointestinal Oncology research team could learn this information. If you are not interested in the study, then any personal information provided during this screening will be destroyed.

There are no benefits to you to taking part in this screening interview. However, it is possible that the information from the study that we will be doing may help researchers to learn more about Neuroendocrine tumors and may benefit others in the future.

The benefit to you of being in our database is that you will hear about studies in the future in which you may be interested.

You are in no way obligated to answer these questions or add your information to our Neuroendocrine Tumor Registry.

You will not be paid for answering questions in this online screening since it is only to see whether you qualify to take part in the study, and whether you want to be part of a database of people who are contacted about future studies. You should also be aware that there is no financial compensation for participation in the Neuroendocrine Tumor Registry

If you have any questions, concerns, or complaints about this screening, contact Hema Vairamuthu at 650-723-0186. If you want to talk to someone separate from the research team about a concern or complaint or your rights as a possible research subject, please contact the Stanford Institutional Review Board (IRB) to speak to an informed person who is separate from the research team, at 650-723-5244 (for medical studies), 650-723-2480 (for nonmedical studies), or toll-free at 1-866-680-2906. In addition, please call the Stanford IRB at these numbers if you cannot reach the research team.

If you consent to take part in the screening process, please select "Yes." You will be directed to a new page containing the screening questions. If you are found to be eligible to participate, you will receive the full consent shortly.

You have selected an option that triggers this survey to end right now.