The researcher requests your consent for the participation in a study about investigating the efficacy of a nutritional supplement called MindGain on cognitive performance in healthy adults.Â
This consent form asks you to allow the researcher to view the results of this questionnaire and assess your eligibility to participate in this study. This questionnaire asks for your name, date of birth, gender, email address and postal code. You will also be asked to provide your phone number at the end of the questionnaire to be contacted by phone to further explore eligibility and discuss next steps on the study. If you are not eligible for the study, an email will be sent to you.
Participation in this study is completely voluntary. If you decide not to participate, there will not be any negative consequences. Please be aware that if you decide to participate, you may stop participating at any time and you may decide not to answer specific question.Â
The researcher will maintain the confidentiality of the research records or data. After screening questionnaire, if you are eligible, information from this questionnaire such as name, date of birth, email address and results of the questionnaire will be transferred to a log paper sheet to be kept for study record. If you are not eligible, only your name and email address will be kept for study records in log paper sheet form. Screening online questionnaire will be immediately deleted following information transfers to paper study log.
For full study details, see our full consent form:Â Â
Consent Form
By submitting this form, you are indicating that you have read the study consent form. You are also aware that by agreeing to participate in study by signing this online consent form, this does not make you automatically eligible to participate in this study. Following this screening questionnaire, if you are eligible, you will be contacted by phone for a further screening interview. After completion of this screening questionnaire and phone interview, participants who are eligible will be invited to participate in the 3-4-week trial. Participants will be emailed a copy of the consent form. Only if you consent to participate then by signing your name, you will be randomized into this study (MindGain vs placebo). Since this is a a randomized, double-blind, placebo-controlled, crossover, you will receive both MindGain and the placebo.
If you have any questions, or would like to discuss the study before completing this screening questionnaire, please contact Dr. Delphie Dugal-Tessier at delphie@staterra.ca.
Thank you in advance for your participation!
Dr. Delphie Dugal-Tessier