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We invite you to join EaseVR's pilot program

Pilot Testing Consent Form - Pilot launching february 2019

The new EaseVR is expected to be available in Summer 2019. Prior to launch, we are conducting a pilot program that allows users to try the program in exchange for their feedback. If you are interested in participating in the pilot, please review the terms of the pilot and request enrollment below. An appliedVR representative will follow up should you qualify for the pilot.

What is easeVR?

EaseVR is a new virtual reality experience that incorporates guided breathing exercises, mindfulness, coping skills training, and pain education in an immersive virtual environment.

For 21 days, you will be asked to use an Oculus Go virtual reality headset to view 3D video and audio for 5-10 minutes at a time and to complete a series of surveys through email/web links.

what do i have to do in the pilot?

If you agree to be part of the research study, you will be asked to use the virtual reality program for 21 days. 

During the 21 days, you will be asked to monitor your levels via an online survey link accessible through your mobile device. Within 2 weeks after completion of the 21-day program, you will be contacted via email or phone to participate in a 30 to 45-minute interview to provide your feedback on the VR experience.

will i need to pay to participate?

No, there is no cost to participate in this study. In exchange for your participation, you will receive a VR kit (Oculus Go VR headset) for use during the study period. You will be asked to return this kit at the completion of the study. You will also be asked to complete surveys via a weblink on your own mobile device.

POTENTIAL RISKS & DISCOMFORTS

appliedVR has taken steps to minimize the risks of this study. Potential side effects may include motion sickness, dizziness, eye strain, headaches or other visual abnormalities. A very small subset of patients (up to 0.025%) may experience severe symptoms (e.g. disorientation, nausea or drowsiness) upon using VR. You can remove the headset at anytime if you feel any discomfort during the experience.

Please inform appliedVR if you have a history of seizures or epilepsy, if you are prone to motion sickness, or if you have any other injuries or health problems related to your participation in this study.

CONFIDENTIALITY

Authorization to release your protected health information

Agreeing to be in this study gives appliedVR your permission to obtain, use, and share information about you for this study, and is required in order for you to take part in the study. Information about you may be obtained from your doctor and/or other health care provider involved in your care.

There are many reasons why information about you may be used or seen by the researchers or others during or after this study.  Examples include giving researchers the ability to distinguish which types of patients are most receptive to the virtual reality experience.

To keep your information safe, the researchers will keep all medical information, or any personal information that could be used to identify you in a secure file separate from your name. The data you provide will be and stored in a secure file.  Any medical related information will be stored independent from your name.

Participating in this study is completely voluntary.  Even if you decide to participate now, you may change your mind and stop at any time. You may also want to discuss it with your health care provider.

CONTACT

If you have questions about this study you may contact appliedVR Research by e-mail at research@appliedvr.io.

CONSENT

Please complete the form below and check "I agree to participate in the study" to sign up. 

Name *
Name
Phone *
Phone
Have you participated in a prior EaseVR pilot? *
Please rate the general level of chronic pain you suffer from. *
Do you have a history of seizures or epilepsy? *
Where is your pain located *
Agree to Participate *