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Submission: On August 25 via api from US — Scanned from DE

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Text Content

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KJT GROUP IS A MARKET RESEARCH AND CONSULTING FIRM BASED IN THE UNITED STATES.
WE ARE CONDUCTING THIS RESEARCH TO HELP THE HEALTH INSURANCE PROVIDER
(“SPONSOR”) DEVELOP NEW HEALTHCARE PRODUCTS AND SERVICES. WE ARE COLLECTING DATA
FROM RESPONDENTS LIKE YOU RELATED TO PROVIDING HEALTHCARE SERVICES. BEFORE WE
BEGIN, WE WOULD LIKE YOUR CONSENT TO PARTICIPATE. THIS NOTICE AND CONSENT TO USE
YOUR PERSONAL INFORMATION DESCRIBES HOW KJT GROUP (MARKET RESEARCH COMPANY) WILL
USE YOUR INFORMATION TO CONDUCT STUDIES ON BEHALF OF THE SPONSOR.

YOUR PARTICIPATION INVOLVES COMPLETING A 25-MINUTE ONLINE SURVEY. IF YOU QUALIFY
FOR AND PROVIDE FULL PARTICIPATION, YOU WILL RECEIVE THE HONORARIUM LISTED IN
YOUR INVITATION. YOUR PARTICIPATION IS VOLUNTARY, AND YOU MAY CHOOSE TO STOP
PARTICIPATING AT ANY TIME.

YOUR RESPONSES WILL BE KEPT STRICTLY CONFIDENTIAL AND WILL NEVER BE SHARED WITH
THE SPONSOR (DOUBLE-BLIND).

YOU HEREBY CONSENT THAT YOUR PERSONAL INFORMATION CAN BE USED:
 1. TO CONDUCT RESEARCH ON BEHALF OF KJT GROUP AND THE SPONSOR;
 2. TO PROVIDE RESULTS OF RESEARCH TO THE SPONSOR;
 3. FOR GENERAL ADMINISTRATIVE ACTIVITIES; AND
 4. TO COMPLY WITH LEGAL AND REGULATORY REQUIREMENTS AND INQUIRIES.



IF A NEW PURPOSE ARISES, KJT GROUP WILL SEEK YOUR APPROVAL BEFORE USING YOUR
INFORMATION.

ADDITIONALLY, YOU HEREBY CONSENT THAT:
 * WE WILL REMOVE YOUR PERSONAL INFORMATION WITHIN 12 MONTHS OF DATA COLLECTION.
 * YOU HAVE THE RIGHT TO ACCESS YOUR DATA, AMEND YOUR DATA, LIMIT USE OF YOUR
   DATA, OR ERASE YOUR DATA AT ANY TIME.
 * YOUR PARTICIPATION IS VOLUNTARY, AND YOU MAY CHOOSE TO STOP PARTICIPATING AT
   ANY TIME.



BY CLICKING THE FORWARD ARROW, YOU AGREE:
 * I HAVE REVIEWED THE ABOVE INFORMATION THAT EXPLAINS THE RESEARCH AND HOW KJT
   GROUP WILL USE MY PERSONAL INFORMATION.
 * I CONSENT TO KJT GROUP’S USE OF MY PERSONAL INFORMATION. I UNDERSTAND THAT I
   CAN MODIFY OR WITHDRAW MY CONSENT FOR THE FUTURE USE OF MY PERSONAL
   INFORMATION BY CONTACTING COMPLIANCE@KJTGROUP.COM, BUT THAT MY WITHDRAWAL OF
   A PREVIOUS CONSENT WILL NOT APPLY TO THE EXTENT THAT KJT GROUP PREVIOUSLY
   RELIED ON MY CONSENT.




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