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Preamble and Consent

Preamble Statement

We are conducting a research study to gain a better understanding of Canadian Family Physician’s knowledge to and attitudes towards sickness/disability certification. The Ontario Disability Support Program (ODSP) is not the focus of this survey. We are interested in sickness/disability certification for employed patients, such as private disability, Workers' Compensation, motor vehicle insurance, and sick notes/letters for employers. The results of this study will provide information critical to planning studies to improve the sickness/disability certification process. Dr. Jason Busse is the primary investigator in this project. We are inviting you to complete a 33-question survey that will take you 5 minutes. Complete by checking the one box (unless otherwise stated) that best reflects your answer to each question. The report of the results will be in an aggregate format without identifying information for particular participants. All responses will be kept confidential.


Ethics Details

There may not be any direct benefit to you by participating in this survey. You can choose whether to complete this survey or not, and by returning the survey, it is implied that you consent to having your data included in this research study. After survey submission, all responses will be anonymized. Thus, we will be unable to accommodate any requests to withdraw your completed survey. You may also refuse to answer any questions you do not want to answer and still remain in the study.

You are not waiving any legal claims, rights or remedies because of your participation in this research study. This study has been reviewed and received ethics clearance through the Hamilton Integrated Research Ethics Board (project #12775).

We greatly appreciate your time and cooperation.


Jason Busse, DC, PhD                 
Associate Professor, Department of Anesthesia     
McMaster University

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Consent to Participate
Having read the above, I understand that by clicking the “Yes” button below, I agree to take part in this study under the terms and conditions outlined in the accompanied letter of information.