This research consent agreement defines your agreement to become a volunteer in the Ambien Experiences research study. This study is the personal research of Sheldon B. Cohen, MD, a practicing psychiatrist in Atlanta, Georgia.
The Ambien Experiences study will enable Dr. Sheldon B. Cohen to evaluate the effectiveness of Ambien and Ambien CR (zolpidem) based on experiences reported by patients who have taken the medication. Dr. Cohen will seek to publish the results of this study in a peer-reviewed medical journal.
You can participate in this study by filling out and submitting the Ambien Experiences form accessed through this Web site (www.ambienexperiences.com).
If the confidentiality of your responses were to be breached, any information that you submitted will no longer be private.
The results of this study will be used to inform the medical community and the public about the effectiveness of Ambien (zolpidem). You will not be compensated financially for your participation in this study. If you indicate your interest in receiving a copy of the study results, Dr. Cohen will send the results to the email address you provide on the form.
Your participation in this study will be anonymous, except for the use of your email address to submit your information and, optionally, receive the results of the study. Your email address will be used only for purposes of this study. Your email address will not be disclosed to any other individual or organization. Data from the study will be reported without any reference to your identity or email address. However, if required by law, your email address may be disclosed.
Your participation in this study is voluntary.
When you submit your data using the Ambien Experiences form, you acknowledge that you have read this consent agreement and are willing to participate in this study. Keep a copy of this agreement for your records. You do not waive any of your legal rights by agreeing to participate in this study.
Please direct any questions about the Ambien Experiences study to Dr. Sheldon B. Cohen, MD.
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