Enrollment Form & Client Consent

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Thank you for your interest in participating in the UF GALLOP Study!

Please complete the Client Consent and Enrollment Form below.

Thank you!

Welcome to the University of Florida Gallop Participant Survey!

The University of Florida is conducting a study to better understand pain sensation in horses with naturally occurring osteoarthritis (OA). Our research team is conducting this study with the goal to provide new methods for measuring pain perception that could be beneficial in both equine and human populations.

This survey is designed to determine if your horse meets enrollment criteria for study participation. If your horse meets study enrollment criteria, our research team will coordinate with you to schedule farm visits to collect necessary samples and conduct a series of behavioral tests.

Please answer all questions in this survey, using estimates if necessary. This survey takes approximately 15 minutes to complete, and is best viewed from a computer. If you would like to submit multiple horses for inclusion in this study, you will need to complete an additional survey for each horse. We highly encourage owners of horses diagnosed with fetlock OA to also submit another form for their sound horses, as they serve as excellent control subjects.

Your participation is highly valuable; however, it is also completely voluntary, and you may elect to withdraw from the study at any time. Our research team does not present any direct benefits, risks, or compensation to you for participating in the study. We encourage you to maintain regularly scheduled appointments with your veterinarian, as our team cannot provide any treatment or medical advice.

If you have any questions or concerns regarding this study, please contact our research team at uf-gallop@ufl.edu.

EQUINE PAIN STUDY - CONSENT, WAIVER, AND RELEASE

The University of Florida ("UF") is conducting a study of horse sensation and arthritis discomfort (the "Study") and I, the undersigned ("Owner"), desire to include the animal(s) (the "Horse" or "Horses") as subjects in the Study. In connection with my participation in the Study, I am executing this Consent, Waiver, and Release (the "Consent") and I hereby acknowledge and agree to the following:

1. I represent that I am the sole owner, or an authorized agent of the owner, of the Horse/Horses and have the authority to enter into this Consent without the joinder or consent of any other party, and that the Horse/Horses are regularly stabled at the specified address (the "Location").

2. During the term of the Study, UF technicians or veterinarians are permitted, upon prior notice to me, to visit the Location to collect blood and hair samples from the Horse/Horses. At my discretion, I or a licensed veterinarian acting on my behalf may collect the samples instead, and I understand that sample collection may occur on more than one occasion. The sample collection procedures present minimal risk, but I recognize that on very rare occasions the Horse/Horses could suffer injuries during restraint or as the result of collecting blood samples.

3. During the term of the Study, UF technicians or veterinarians are permitted, upon prior notice to me, to visit the Location to perform radiographic imaging (X-Rays) to establish the health of the Horse/Horses joints. Sedation may be used, with my permission, to facilitate calming of the horse to allow the capture of clear images.

4. Study staff may need to conduct examinations to evaluate the Horse/Horses movement, which may include, but is not limited to the following: Have the Horse stand quietly for a physical exam; have the Horse stand quietly while touched using non-invasive tools that allow Study staff to measure the Horse's ability to sense its environment; have the Horse walk calmly along a straight path; and have the Horse trot calmly along a straight path. I authorize Study staff to prompt the Horse/Horses to perform these movements as part of the Study.

5. The study will require each participant Horse to wear non-invasive sensors including a heart rate monitor, an activity monitoring device during turn-out to monitor voluntary movement behaviors, and a set of standard sport boots equipped with sensors may be used to measure limb motion and I understand that my Horse/Horses might react negatively to this type of equipment. I understand that the study is designed to observe natural reactions of each Horse, and that for the well-being of participant Horses, UF will aim to avoid any negative experience during the study.

6. I understand that the Study will require each horse to receive a dose of phenylbutazone ("bute"), a common pain reliever, and I consent to the use of these pain relievers on my Horse/Horses. I understand that I may be responsible for the administration of these pain relievers, and I agree to administer them as instructed by UF. If the Horse/Horses has/have any type of known allergy or sensitivity to these pain relievers, I will notify UF in advance of the Study.

7. I also consent that, at the Location, and at public events, UF may photograph or video record me and my animal's appearance, image, and likeness on film, photograph, video or in any other electronic medium, or may receive images of my and/or my animal's appearance, image and likeness that I provide ("Materials"). I hereby unconditionally and irrevocably consent to the UF's use and display of such Materials for educational, archival, acknowledgement or general research purposes, including the right to publish the Materials in any form of publication that disseminates research and educational information in any format, including but not limited to print, electronic, video or Internet. These recordings may include overnight continuous observations of the Horse's natural behavior in its stall, and of the horse during the exams.

8. My participation in the Study is voluntary, and that I may withdraw the Horse/Horses from the Study at any time by notifying UF.

9. UF may publish, or authorize others to publish, the findings acquired from the Study for the benefit of the horse industry, veterinary medicine, and other interested groups, but UF will not knowingly or intentionally reveal the identities of the Study participants or other confidential information unless required by law or a court order. To the extent permitted by law, UF will keep confidential all identifying Study data, which UF will use only for research purposes. Confidential information does not include information that is: (a) publicly available; (b) known to a third party prior to UF's disclosure; or (c) subsequently lawfully obtained by a third party without obligations of confidentiality.

10. The Study is not designed to provide, nor will UF provide, any management or veterinary advice to me.

11. UF shall not be responsible for any nutritional, grooming, veterinary or any other needs of the Horses at any time; such needs shall be my sole responsibility at all times.

12. All risk of loss to the Horse/Horses through natural or accidental occurrence shall be borne by me, and UF shall not be responsible or liable for damage or death to one or more of the Horse/Horses, whether caused by UF's negligence or otherwise. I, as Owner, hereby release, discharge, and hold harmless UF and its officers, trustees, directors, employees, representatives, agents, and volunteers (collectively, the "Releasees"), for, from, and against any and all liability and responsibility whatsoever, however caused, for any and all damages, demands, claims, actions or causes of actions, including damage or death to any of the Horses arising out of (either directly or indirectly) damage to, or caused by, the Horses, whether caused by the negligence of the Releasees, a third party, or otherwise.

13. Nothing contained herein shall be construed or interpreted as: (a) denying to UF or Owner any remedy or defense available to such party under the laws of the State of Florida; (b) the consent of UF or the State of Florida or their agents and agencies to be sued; or (c) a waiver of either UF's or the State of Florida's sovereign immunity beyond the limited waiver provided in section 768.28, Florida Statutes.

14. This Consent and all activities contemplated herein will be governed by, and construed and enforced in accordance with, the laws of the State of Florida. In the event of any legal or equitable action arising from the Study, the jurisdiction and venue of such action shall lie exclusively within the courts of record of the State of Florida located in Alachua County, Florida.

15. I have indicated by checking the appropriate box below as to whether I would like to be contacted regarding follow-up information about my Horse/Horses, or to receive information about the progress of UF's research.

Would you like future correspondence regarding follow-up information on your horse(s), or updates on the progress of this research study to be sent to the email you have provided below?

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No, please do not contact me.

Yes, please contact me with follow-up information on my horse and with updates on study progression.

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Please sign below to acknowledge that you are at least 18 years of age, have read the information above, and hereby are providing consent to the release of your horse's information and participation in the Equine Pain Study.

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Full Name:

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Email Address:

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Phone Number:

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Address:

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Zip Code:

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Owner's Full Name:

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Owner's Email Address:

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Owner's Phone Number:

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Is this the first survey submission you are completing for this study?

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Yes

No, I am providing information for an additional horse.

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How did you hear about this research study?

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Flyer

Social media

Vet referral

Horse event/conference

Research team recruiter

Other

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Mark field as:

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-88 (Missing)

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To save your responses and end the survey, click the 'End Survey' button below. If you have selected the wrong option by accident and/or wish to return to the survey, click the 'Return and Edit Response' button.