Wello's Brown County Community Health Panel
All information is required to submit the form.
First Name *
Last Name *
Email *
Informed Consent
Welcome: You are invited to participate in a community-wide study that assesses well-being.

Investigators & Purpose of Study: The purpose of this study is to aid efforts to improve quality of life in Brown County. Wello is a non-profit organization with the mission to create environments in the community that support and promote all residents' well-being. The shared vision is to make the Greater Green Bay Area the healthiest community in the nation. By joining this panel, you will help Wello effectively reach this goal and ensure all of the unique needs of our community members are met. This survey is coordinated by Dr. Jenell Holstead (UW-Green Bay) and Dr. Jamie Lynch (St. Norbert College).

Confidentiality: You will be asked to provide answers to a series of questions related to well-being. Should you decide to participate in this study you may access the anonymous and confidential survey by clicking on the “Next Page” button below. There is no more than minimal risks from your involvement in this research. Potential benefits include contributing to a better understanding of well-being. Your name will not be associated with your responses and your responses will be kept confidential.

The results of this research may be shared with community organizations or published, but individual participants’ identities will not be known. Individual responses are confidential and recorded online through a secure online survey tool. Data will be kept in the strictest confidence. The researchers retain the right to use and publish non-identifiable data. Aggregate data will be presented representing averages or generalizations about the responses as a whole. All data will be stored on a secure server accessible only to the researchers.

Participation & Withdrawal: Your participation is entirely voluntary. You are free to choose not to participate. Should you choose to participate, you can withdraw at any time without consequences of any kind. You may leave blank any questions you do not wish to answer. Once your responses have been submitted and anonymously recorded you will not be able to withdraw from the study.

​Questions: You may have questions or concerns during the time of your participation in this study, or after its completion. If you have any questions, you may contact Jenell Holstead (holsteaj@uwgb.edu) . For questions about your rights as a research subject, you may contact the chair of UWGB’s Institutional Review Board (IRB), Dr. Illene Cupit at (920) 465-2703 or cupiti@uwgb.edu.

Giving of Consent
I have read this consent form and I understand what is being requested of me as a participant in this study. I freely consent to participate. I certify that I am at least 18 years of age. By clicking YES, and completing and submitting this anonymous online survey, I am consenting to participate in this research.
Consent? *
Questions? Email hello@wello.org
Submit
Never submit passwords through Google Forms.
This form was created inside of Wello. Report Abuse