Participant's Pre-Survey - C19 Insider Scoop
What is your alias name, one which can be used to publicly acknowledge your support and participation? e.g. MP32
To protect the privacy of all participants, please create an anonymous alias such as MP32 for Mary Poppins.
Are you 18-years or older? *
To be eligible for this study, you must be 18-years or older.
Are you a resident of the United States? *
To be eligible for this study, you must live in the U.S.
Did you test positive for COVID-19 or test positive for COVID-19 antibodies? *
Testing positive for COVID-19 or antibodies is required for participation in this study.
Have you recovered from majority of your symptoms of COVID-19? *
To be eligible for this study, you should not have been recently diagnosed (e.g. within the last 2 weeks).
What is an email address through which we can send the password for full participation in the C19 Insider Scoop study? *
If you qualify for the incentive (our way of saying thank you), how would you like to receive it?
Clear selection
Name and Mailing address (optional)
This is only required for persons who requested a physical incentive sent by mail.
Any questions, comments, or feedback
This space can be used to provide additional context/details for persons interested in participation who did not receive a positive test for COVID-19 or antibodies but experienced COVID-like symptoms.
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This form was created inside of Dartmouth College.