By taking a few minutes to complete this form, your responses will be included in information used to determine if or how this study will be conducted. Your input is important to us, and will aid us in our future decisions regarding this study.

If you have not yet viewed the Tranexamic Acid study presentation:

Click HERE for web presentation
(requires no additional software besides your web browser)

Please answer ALL questions - if you have no response for any of the questions, please type in 'no response' or 'N/A'. If any questions are left blank, it will cause an error and won't send the information.

1. Do you live in Texas? Yes   No

2. If   NO, you do not live in Texas, please click here to exit and discontinue questionnaire.

If   YES, you DO live in Texas, which county do you live in?    

3. Did the presentation help you to understand what this study is about?

Yes   No

4. In your own words, describe the purpose of this study and how it will be conducted, as you understand it:

5. Patients enrolled in this study will not be giving their informed consent before they become participants. Instead, your community is assisting in the approval of this study.

Do you understand the reasons for this? Yes   No

6. Do you think it is ok to enroll in this study without consent? Yes   No

7. Do you feel it is acceptable to conduct the study? Yes   No

If no, why not?

Gender (check one):   Male     Female


The following section is optional.


Ethnic background:

Prove you are a human: What is 2 plus 1?


Click here to review your information before sending



Return to Surgery homepage.

Principal Investigator: Brian Eastridge, MD, UTHSCSA Department of Surgery, 7703 Floyd Curl Drive, San Antonio, TX 78229-3900. Questions or comments? Phone 800-316-8484 or email
© 2015 UTHSCSA Trauma & Emergency Surgery, Department of Surgery. All rights reserved. | Institutional Review Board
Read our usage, copyright statement UTHSCSA Privacy Statement | Email webmaster
Updated 18 December 2015