Screen Reader Mode Icon
This survey is used to determine your eligibility to participate in an interview study regarding GLP1 medication cessation. This is an academic study to determine reasons and effects of stopping these medications. Any information obtained will not be used for any commercial purposes. Individuals information will be kept confidential from this enrollment survey and from the study itself. Those who complete the survey and the interview will be compensated with a $20 Amazon gift card.

The last survey question will be to determine if you want to participate in the above mentioned interview. If you meet the eligibility criteria and select "yes", you will be given instructions on the next step to participate in the Zoom interview, which will be scheduled after survey completion. We anticipate the interview will take about 30-60 minutes.

Question Title

* 1. Please provide your date of birth

Date

Question Title

* 2. Please provide your first name

Question Title

* 3. Have you previously taken and since stopped any of the following medications?

Question Title

* 4. How long did you take the medication?

Question Title

* 5. Do you have one of the following conditions?

Question Title

* 6. Are you interested in participating in this interview study?

Question Title

* 7. How do you prefer we contact you?

Question Title

* 8. Please enter your contact information (either phone # or email address)

0 of 8 answered
 

T