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By using CheckUp, you agree to our Terms and privacy
Please review the form below before tapping "Agree" if you're ready to continue.
Consent to Participate in a Research Study
CheckUp (the "Study")
Consent Form Version Date: 03/26/20
Name of Organization: CheckUp, LLC
Study Contact Email: email@example.com
Research studies aim to obtain new knowledge. This new information may help people in the future. It is important that you understand the information in Part 1 of this document so that you can make an informed choice about participating in this Study in Part 2, below.
The purpose of this Study is to collect data that is useful for the diagnosis of patients based on voice analysis. We aim to apply machine learning techniques, digital processing, and artificial intelligence to analyze voice data. At this stage, we are simply collecting information to be made available to the research community and advance rapid new techniques for the detection of patterns and markers in voice data.
Participation in this Study involves using CheckUp's mobile app on your personal device.
Upon providing your consent and agreement to participate in the Study, you will be asked to:
Register an account: Once you provide your consent to participate in the Study, all participants will complete an electronic registration process through the mobile app and create a user account. Registration will include entering your email address and other general information about yourself.
Complete a personal health Questionnaire: You will be provided with a questionnaire about your demographics, health history and past diagnoses. Your answers to these questions will help us find patterns in underlying conditions of certain diagnoses. Some of the questions may be personal in nature. You may choose to leave blank any questions you do not wish to answer.
Provide Audio Recordings: You will be provided with reading material and asked to use the mobile app to record and submit audio recordings of you reading the material aloud.
After you complete the Study, we may, from time to time, and with your consent, send you notices to your phone or e-mail asking you to complete additional questions or request further voice samples. You may choose to complete any additional questions or provide additional voice samples at your convenience and discretion. You can use the notification settings on your device for the mobile app to control or turn off the notifications.
You should not be in this Study if you are under 18 years old at the time of participation.
This Study is designed to benefit society by gaining new techniques to screen for and create methods for early detection of potential illnesses. There are no direct medical benefits to you and no incentives of any kind, monetary nor otherwise, will be provided to participants for taking part in this Study.
There are discomforts and inconveniences associated with any research study. These deserve careful consideration.
This Study involves a difficult subject matter, including providing health information, which may cause emotional discomfort. Please keep in mind that you have the chance to skip questions that make you uncomfortable or to stop participating at any point.
All information provided by you, including your name, medical history, and other personal information will be kept confidential by CheckUp, unless disclosure is compelled by law.
Anonymized information collected during this Study may be transferred to third parties for related research purposes. Anonymized information collected during this Study may also be used in analyses and may be published and presented to the scientific community at meetings and in journals. If the results of this Study are published, your identity will remain confidential. Anonymized information may also be used as part of a submission to regulatory authorities around the world to support the approval of CheckUp's voice analysis tool as a screening method for various illnesses.
Even though the likelihood that someone may identify you from the Study data is very small, it can never be completely eliminated.
Any information and voice samples sent outside across borders may increase the risk of disclosure of information because the laws dealing with protection of information may not be as strict in the other countries. However, all information and voice samples that are transferred across borders will be coded (this means it will not contain your personal identifying information such as your name, address, or contact information). By signing this consent form, you are consenting to the disclosure of your coded information to organizations located in other countries, as applicable.
Note that, data collected on the device you use to download CheckUp's mobile app may reside on the device manufacturers' servers and CheckUp does not make any representations or assurances with respect to such manufacturers' confidentiality policies.
Communication via e-mail is not absolutely secure. We do not recommend that you communicate sensitive personal information via e-mail.
Your participation in this Study is completely voluntary. You may decide not to be in this Study. You may refuse to answer questions you do not want to answer. Agreeing to participate does not waive your legal rights.
You can choose to end your participation in this Study at any time without having to provide a reason. Your decision not to participate in or withdraw from the Study will not affect your relationship with CheckUp, or any other organization associated with this project. Upon your withdrawal, all associated data collected will be immediately destroyed wherever possible.
If you no longer want your information, including your voice samples, to be used in the Study after you have submitted it to CheckUp,, you should notify us at firstname.lastname@example.org to destroy the information you provided. If your information has already been anonymized at the time of notification, it may not be possible to withdraw it because we will not be able to identify which data set is yours.
You have the right to ask, and have answered, any questions you may have about this Study. If you have questions about the Study, complaints, feedback, or concerns, you should contact us at email@example.com.
By tapping the "Agree" button, you agree with all of the following statements:
I have read the foregoing information (or it has been read to me). All my questions about the Study have been answered to my satisfaction and I understand that I can ask further questions about the Study at any time.
I consent voluntarily to be a participant in this Study and understand that I can refuse to answer questions and that I can withdraw from the Study without reason at any time.
I understand that taking part in this Study involves providing answers about my medical history and previous diagnoses, if applicable, and audio recordings of my voice.
I understand that the information I provide will be used to help develop a new screening method using voice samples for early detection of illness.
I understand that my personal identifying information will be held in confidence, to the extent permitted by law, and my identity will not be disclosed in any publication or presentation. I further understand that CheckUp cannot guarantee complete confidentiality of the information I share in this Study.
I understand that there is no compensation for my participation in this Study and this Study will not benefit me specifically.
I give permission to CheckUp to store the information I provide during this Study, including my audio recordings, so it can be used for future voice analysis research by CheckUp.