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Intake Form - Participatory Surveillance

Please complete the form below.

Thank you!

PREPARED Study

SARS, SARS-CoV-2, H1N1, mpox and other pandemics revealed the inadequacy of Canada's early warning and surveillance systems. Thus, PREPARED has been launched as a national network for the active surveillance of acute respiratory infections. Participating in this study will contribute to valuable data that has the potential to improve diagnostic accuracy and treatment for individuals with respiratory illnesses. However, please do note that this study itself is not offering any diagnostic or therapeutic services and that participation is solely for research purposes.

We are looking for volunteers with ongoing symptoms of respiratory illness and willing to self-test themselves with a nasal swab.

We are recruiting participants in six provinces, across Canada for this study: Ontario, Quebec, Alberta, Manitoba, Newfoundland, and British Columbia. You can participate from your own home. No face-to-face visits are required.

If you wish to be considered for this study, as a participant, please answer the following questions to determine your eligibility.

The information will be collected and stored securely using REDCap, a secure, encrypted database with strict access controls. Only authorized study personnel at Unity Health Toronto will have access to the responses, and all information will be handled in compliance with applicable privacy regulations.

If you have any questions about providing your consent or about your rights as an individual expressing interest in the PREPARED study, please contact the Unity Health Toronto Research Ethics Board at (416)-864-6060 ext. 2557. When inquiring, please reference REB# 24-161, which pertains to this PREPARED initiative.

By completing the intake form and providing your contact information below you are indicating that you have read the above consent form and consent to having your contact and eligibility information collected for the purpose of letting you know about the PREPARED study. If you choose not to consent, please feel free to close your browser and exit now.

1. Do you live in one of the following provinces?

* must provide value

Ontario

Quebec

Alberta

Manitoba

Newfoundland

British Columbia

None of the above

reset

At home testing as part of the PREPARED study has not yet launched in the province you have selected. Please sign up and follow the PREPARED newsletter for more information and updates on when it starts in your selected province.

Newsletter Sign Up Link: https://mailchi.mp/495f5d882d99/prepared-initiative

Do you live in one of the following postal codes?

* must provide value

M3J

M3K

M3L

M3M

M3N

M6L

None of the above

reset

At home testing as part of the PREPARED study has not yet launched in your selected area. Please sign up and follow the PREPARED newsletter for more information and updates on when it starts in your area.

Newsletter Sign Up Link: https://mailchi.mp/495f5d882d99/prepared-initiative

2. Are you currently experiencing (at least two) of the following respiratory symptoms?

runny nose
cough
fever
wheezing
sore throat
nasal congestion
shortness of breath
fatigue
rapid breathing
excessive mucus production
loss of smell or taste
presence of blood in your sputum
trouble sleeping due to breathing difficulties

* must provide value

Yes

reset

3. Did the symptoms begin in the last 6 days?

* must provide value

Yes

reset

4. Are you willing to self-test yourself with a nasal swab?

* must provide value

Yes

reset

Thank you for your time and interest. Unfortunately, you are not eligible to take part in this study.

Please sign up and follow the PREPARED newsletter for more information and updates

Newsletter Sign Up Link: https://mailchi.mp/495f5d882d99/prepared-initiative

Thank you for your time and interest. You are eligible to take part in this study. If you are interested to learn more about the PREPARED initiative, please leave your name and contact information and one of our team members will reach out to you as soon as possible:

Your personal information will be collected and stored securely using REDCap, a secure, encrypted database with strict access controls. Only authorized study personnel at Unity Health Toronto will have access to your data, and all information will be handled in compliance with applicable privacy regulations, including the Personal Health Information Protection Act (PHIPA).

The information you provide will be retained until March 2028 or until we are complete recruitment, whichever is later. You have the right to withdraw your consent and request the removal of your information at any time. If you have any questions about how your data is managed or wish to withdraw, please contact prepared@unityhealth.to

By submitting the answers below, you acknowledge that you understand how your personal information will be protected and agree to provide your personal information. The information that you provide will not ll not be used in the future or for other purposes not mentioned in this document.

If you do not wish to be contacted by the research study staff, please feel free to close your browser and exit now.

If you do provide your contact information and change your mind about participation, you can contact prepared@unityhealth.to or let the staff know when they call. You should anticipate a call within 24 hours if it is a business day or the next available business day if it is a weekend.

Your name:

Email Address:

Preferred Phone Number:

Home Address:

* must provide value

Expand

Any specific instructions (for contacting you):

Expand

You have selected an option that triggers this survey to end right now.

To save your responses and end the survey, click the 'End Survey' button below. If you have selected the wrong option by accident and/or wish to return to the survey, click the 'Return and Edit Response' button.