Please read carefully.

We invite you to complete this questionnaire if you are interested in being entered into our database of potential trial participants. As a trial participant, you may be able to try the latest Philips Respironics products and provide valuable input that will help us better understand your needs and provide a more comfortable sleep therapy experience.

Your completion of this survey and participation in any trials is entirely voluntary. Philips Respironics will keep any information that you provide strictly confidential using appropriate safeguards. The information on your completed survey will be used by Philips Respironics only for internal research purposes to determine whether you are a possible candidate for a product trial and to gain a better understanding of the needs of sleep apnea patients like you. 

Acknowledgement and consent to use information

I voluntarily agree to provide my personal information contained in this completed survey as it relates to my current sleep condition. By completing this survey, I am agreeing to be included in Philips Respironics’ database of potential trial participants. I understand that I am providing and allowing Philips Respironics to collect, review, and record basic personal information about me and information regarding my health (type and severity of sleep disorder, other medical conditions, etc.) only for purposes of determining whether I may be a candidate for participation in product trials or research studies.

I understand that my submission of this survey and agreement to be listed in the database of trial participants does not mean that I am obligated to participate in any future product trials or research studies. I further understand that if I appear to be a possible candidate for a specific research study, I will be contacted (by phone or email) by a member of the Philips Respironics clinical research staff. At that time, the specific study will be explained to me, and if I am interested in participating, I will be asked to complete a separate consent form, which will outline in detail the procedures, risks, and benefits associated with that study.

Philips Respironics will take appropriate measures to keep my personal information confidential and secure and will not use, disclose, or sell my personal information to any third party, except as may be required by applicable law. The information that I am providing is accurate to the best of my knowledge at the time of completing this survey. This authorization may be withdrawn by me at any time by notice to Philips Respironics.

By agreeing to provide this information, I have not waived any other legal rights.

Philips Respironics Product Trial Enrollment Survey