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Health Research Study Feedback Form
Los Angeles County Department of Public Health is coordinating a $25 million, long-term Health Research Study, examining the impacts of the 2015 Aliso Canyon Disaster.
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Email
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Your email
Name
Your answer
Zip Code
Your answer
I live/work in the area impacted by the Disaster.
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Yes
No
Other:
Please list any health issues you, your family or your community have experienced or are experiencing.
Your answer
Please list any former or ongoing environmental exposures you may be concerned about.
Your answer
What are some health study areas of interest for consideration in forming research questions?
Your answer
Effective communication with community members is important for the delivery of the Health Research Study. Do you have any comments, feedback, ideas or suggestion to improve communication and outreach options?
Your answer
Do you have any other comments or feedback?
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Which of the categories below best describes the topic of your feedback?
*
Health Research Study (HRS)
Community Advisory Group (CAG)
Scientific Oversight Committee (SOC)
Other
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Thank you for submitting your feedback. It will be published online to the Feedback Log within 72 hours. You should also receive an email from Google Forms confirming your submission.
Disclaimer: Any sensitive health information provided will not be published online.
A copy of your responses will be emailed to the address you provided.
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