Informed Consent Form

Name of Research Study: A Usability Study to Identify Potential Problems with use of Second Brain’s Digital GI Diagnostic Application, Improve System Design, and Increase the Likelihood of Technology Acceptance among End-Users”

Protocol: SB-001-CL-001

Lead Researcher/Study Manager contact at Second Brain: Courtney Wells, cwellsscra@hotmail.com;

Phone: 7738182111

You are being invited to participate in the research study titled “A Usability Study to Identify Potential Problems with use of Second Brain’s Digital GI Diagnostic Application, Improve System Design, and Increase the Likelihood of Technology Acceptance among End-Users” The purpose of this research study is to identify potential problems or areas for improvement, if any, with use of Second Brain’s Digital GI Diagnostic Application, which is used to collect information on common gut disorders.

If you agree to participate in the study, you will be asked to complete an online diagnostic survey as well as a satisfaction questionnaire; participation is expected to last an hour or less. The study will be open for enrollment for one month, or until approximately 20 volunteers have completed the survey and questionnaire.

There is a potential risk of loss of confidentiality, but the researchers will take steps to protect your health information. Information that we learned about you in this study will be handling a confidential manner and will not be shared with anyone which would identify yourself. However, any health information collected through this diagnostic questionnaire will not be shared with you or any health care provider/other company or any other country, as the information you provide in these questionnaires will not be used or retained for the purpose of this study. There are no other foreseeable risks to participating.

Taking part in this study is voluntary. There will not be any penalty or loss of impact to your future medical care if you decide to leave the study earlier before completing the surveys. There are no direct benefits from participating, but you may help us improve our GI diagnostic application. The researchers for this study are part of Second Brain Healthcare, but there is no financial conflict of interest. You will not be paid for being in this study.

For questions, concerns or complaints about this study, contact the lead researcher listed above, or if you have questions about the research or your rights as a participants and wish to talk to someone not on the study team, you may contact Castle IRB at irbteam@castleirb.com or call 1-888-442-2472 extension 2.