Patient Focus Group

Thank you for your interest in participating in a future focus group session.

Please complete the information below and answer all questions so we can confirm your eligibility! (Questions marked with an asterisk * are required)

[JENCARE-PROD] Patient Focus Group

Patient Name*

First Name

Last Name

Email*

Phone Number*

Do you have a working laptop of desktop computer with stable internet access?*

Yes No

Required to participate

Does your computer have a built-in camera and microphone?*

Yes No

Required to participate

Are you willing to have a focus group representative contact you to confirm your availability and share additional session information?*

Yes No

Required to participate

Terms & Conditions

I am voluntarily agreeing to participate in an upcoming virtual focus group regarding my past experiences with ChenMed (JenCare, Dedicated Senior, or Chen Senior).
If selected, I understand that the session will involve participating in a 60–90-minute video call with a group of other patients. I agree to join the call in a quiet place where I have privacy and am free from distractions. I agree to receive printed materials and use these materials as requested during the session.
I understand that I will be paid $100 for participating in this market research event.
I understand that someone will be reaching out to me to confirm my eligibility, availability to participate, and answer any of my questions.
I agree to the focus group being recorded.
I understand that all information I provide for this research event will be treated confidentially. My identity will remain anonymous in any report out related to this market research study.
I understand that any feedback I provide during the focus group is for the benefit of ChenMed, and I assign to ChenMed the right to use my feedback in any manner it chooses, without further notice or compensation to me.
I understand that individual extracts from the session may be quoted anonymously in a marketing research report.
I understand that if I inform the researcher that either myself or someone else is at risk of harm, they may report this to the relevant authorities - they will discuss this with me first but may be required to report with or without my permission.
I understand that signed consent forms and any related audio/video recordings will be retained in secure digital storage for a minimum of six months.
I understand that a transcript of the session, in which all identifying information has been removed, will be retained for a minimum of six months.
I understand that I am free to contact any of the individuals involved in the focus group research to seek further clarification and information.

I agree to the terms and conditions

I agree to the terms and conditions.

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Thank you for your interest in participating in a future focus group session.