Caspary Research Institute of the Schwarzman Animal Medical Center
INFORMED CLIENT CONSENT FORM
STUDY TRIAL NAME
Survey on owner satisfaction and patient tolerability of hindlimb assistive cart in dogs
PURPOSE OF RESEARCH STUDY
We are asking for your permission to participate in a clinical survey investigation. In order for you to make an informed judgment whether or not to participate, we are providing this information to help you understand the benefits and risks. This process is called informed consent. Your doctor will explain the study protocol (study methods). Enrollment in this study protocol is voluntary. Once you understand the study, you will be asked to sign an informed owner consent form to permit your participation. A copy of the signed consent can be provided upon request to you to keep as a record.
I. Purpose of this Clinical Investigation
The purpose of this clinical investigation is to determine client satisfaction and tolerability of a hindlimb assistive cart for neurologic conditions affecting the mid back (T3-L3).
The goal of this clinical investigation is to determine whether use of hindlimb assistive carts enhances the quality of life of both the client and dog and if the cart is tolerated by the dog.
II. Description of Clinical Investigation
You will be asked to complete a survey regarding cart use, perceived tolerability of the cart by your dog, cart quality, cart accessibility, and overall satisfaction. This survey is estimated to take about 10 minutes.
III. Possible Side Effects of this Clinical Investigation
No side effects are anticipated for your pet associated with this survey study. This study may involve sensitive questions about your pet’s medical history or experience. While most people do not experience negative side effects, some of the questions may be upsetting, stressful, or cause you to feel uncomfortable; however, these are anonymous responses and are not expected to evoke any significant adverse effects.
IV. Potential Benefits
Responses to this survey will provide insight into client satisfaction and dog tolerability, respectively, of a hind limb assistive cart that can be utilized for future management of dogs that are unable to walk independently.
V. Right to Refuse or Withdraw from Clinical Investigation
I understand that I have the right to refuse or withdraw from further participation at any time.
VI. Financial Obligations and Payment for Treatment
I understand that my participation in this clinical investigation is completely voluntary and my refusal to participate will not affect my pet’s care in any way. I understand there are no costs associated with my participation in this study.
VII. Confidentiality
I understand that no personally identifying information will be used in publications or public reports resulting from this clinical investigation.
The veterinarian in charge of this investigation is Dr. Taylor Grimes. If you need more information about this study, please contact Dr. Grimes at 212-329-8610 or e-mail: Taylor.Grimes@amcny.org.