Consent to Contact Form |
Please complete the form below.
If you would like a copy of this form for your records, please email the research team at brainlab.clairvoyant@ubc.ca with your full name and a subject line "Requesting Consent to Contact Form"
The UBC B.R.A.I.N. Lab is inviting paid research volunteers to take part in a study involving individuals with Alcohol Use Disorder (AUD). This study is evaluating the efficacy and safety of psilocybin assisted psychotherapy in adults with AUD. The preliminary trial results concerning this therapy have been encouraging and no serious adverse effects have been observed.
If you are interested in learning more about this study, including your potential involvement as a participant, this form will allow our research staff to reach out to you about your interest. Following this form is a brief screener that will help us determine your eligibility for this study. By signing the form below, you are consenting to the release of your contact information provided on this form along with any information you add on the following form.
At anytime you are free to decline any contact from our research staff and or fully withdraw from this study by notifying one of our research staff.
Study Overview:
1. You will be asked to complete a questionnaire online or over the phone to determine your eligibility.
2. You will be contacted by email with a consent form attached and information on the entire study, including potential risks to determine whether or not you are still interested.
3. If eligible, you will be invited to 13 in-person visits at the lab which include 2 visits of psilocybin or placebo dose administration.
Email Disclosure:
The information you provide will be kept confidential by the research team. However, you should be aware that some webmail services (e.g. Gmail, etc.) may store the contents of your email account outside of Canada (for example, in the United States), where privacy and data security standards may be different than they are in Canada. Under the Freedom of Information and Protection of Privacy Act (British Columbia), we require your consent to send your personal information outside of Canada. Please carefully consider whether your listed email account is secure, whether other people have access to it, or whether you have concerns about the security of any information sent to this account.
Questions:
For questions related to this form, please leave us a message at (604) 827-4287 or brainlab.clairvoyant@ubc.ca. If you have any questions about your rights as a research participant, want to provide feedback, or have a complaint, you may call the UBC Clinical Research Ethics Board (CREB) at (604) 822-8598 or 1 (877) 822-8598.