UNIVERSITY OF CALIFORNIA, DAVIS
BERKELEY  DAVIS  IRVINE  LOS ANGELES  MERCED  RIVERSIDE  SAN DIEGO  SAN FRANCISCO
SANTA BARBARA  SANTA CRUZ
SCHOOL OF MEDICINE
DEPARTMENT OF UROLOGY
4860 Y STREET, SUITE 3500
SACRAMENTO, CALIFORNIA 95817
TELEPHONE : (916) 734-2823
FAX : (916) 734-8094
Dear Sir,
Hello and thank you for your interest in our research project!
Drs. Robert Szabo and Robert Allen (department of orthopedics) and Alan Shindel (department
of urology) are conducting a research project on men with nodules and/or cords in the hand, a
condition called Dupuytren’s disease. You have been invited to participate as you have been
referred to the practice of Dr. Szabo or Dr. Allen for possible Dupuytren’s disease.
We are studying conditions that may be associated with Dupuytren’s disease. The following
survey contains questions about you and about conditions that you may or may not have. Some
of the questions are about sex and may seem very personal. All information gathered will be
anonymous and confidential. We hope that this research will help improve men’s health in
the future. The survey should take about 10 minutes.
When you are done please place the completed survey in the pre-paid envelope provided.
If you complete this survey, you are giving consent for us to use this information for research
purposes. We are not asking for your signature or other identifying information as we do not
want any information that may link you to the responses we receive. Participation in this
research study is completely voluntary. If you decide not to participate it will not influence the
care you will receive at UC Davis.
Thank you again for your consideration and assistance in this important research project! If
you have questions or concerns about this research or topics related to this survey please
contact Dr. Shindel at alan.shindel@ucdmc.ucdavis.edu or at (916) 734-6491. You can also
contact the UC Davis Institutional Review Board Administration at 916-703-9151.
Approved by the University of California, Davis
Institutional Review Board
Protocol
520651-1
DD/PD Survey
Version 2, Dated 10.15.13
Approved
10/30/2013
Expires
10/29/2014