Thank you for your interest in this survey. Its purpose is to better study the health benefits resulting from implementing a low carb elimination diet (the "Revero Method). The survey takes approximately five (5) minutes to complete.
The survey, which is hosted on in the secure, HIPAA-compliant platform QuestionPro, will collect information about you and your experience with various medical conditions and your diet.
By answering the questions below, you agree to authorize the Revero research team, which includes its representatives, collaborators and agents, to use and disclose any or all of the information provided as described above, including, for the following purposes:
- to communicate with you
- to conduct a survey on your experience with relevant health conditions and your diet
- in aggregate form, to compile reports or other communications related to the survey and its results
- link to and/or combine with real-world datasets for research purposes within the scope of this clinical study, and subsequent medical research uses
- Your name, address and date of birth will be shared with a trusted third party organization who will remove your identifiable information and replace it with a unique de-identified number. This de-identified number allows researchers to access and analyze the survey information that you provide in a non-identifiable way. Your personal information will not be shared or used for any other purpose
The information you provide in connection with this survey may include, without limitation, information about your medical history, dietary history, and about medical services and treatments you may have received. Recipients of your information may not be governed by any federal privacy laws. In addition, Revero has taken the appropriate administrative, technical and organizational measures for the protection of confidential data.
For additional information or if any questions or problems arise, please contact the Revero team at email@example.com
This survey is sponsored by Revero, a digital health company, and it does not contain any promotional content or material. By continuing with the survey, you are agreeing that you have read and consent to participate in the study. You must be 18 years or older to complete the survey.
Your participation will not lead to a sales call of any kind. Your participation is voluntary. During your participation, you have the right to refuse to answer any question or withdraw from participation at any time. Your responses will be kept strictly confidential among the parties commissioning and performing the study and will only be used for research purposes.
Once you have reviewed and if you agree to participate, click the Start button below.