If you are unwilling to share any clinical information for research purposes, please indicate why (check as many as you want). | |
▪ Not applicable, I am willing to share this information. | |
▪ It would make me uncomfortable to share this information. | |
▪ I am afraid my information will be used by the government. | |
▪ I don’t trust that my information will be kept confidential. | |
▪ It may compromise my future health care or insurance. |