You are expressing interest in the Allergy and Asthma Network Not One More Life Trusted Messenger TELEHEALTH program. To participate you must live in the United States, be 18 years of age or older, be able to use a smart device for the TELEHEALTH app, use this app daily to monitor/track respiratory health and have the ability to use a camera on a smart device (cell phone, tablet, computer of mobile device). Please complete this survey to express your interest in the TELEHEALTH program. 

Personal Information: This information is required for us to contact you if you qualify to participate. 

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* 1. Type your FIRST and Last Name

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* 2. Type your email address 

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* 3. Type your phone number

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* 4. Have you been diagnosed with asthma or Chronic Obstructive Pulmonary Disease (COPD)? 

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* 5. What is your address (street number, street name, city, state and zip code) 

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* 6. Are you interested in the Not One More Life Trusted Messengers Telehealth program?

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* 7. The Telehealth programs requires you have the ability to use a video camera on a tablet, computer or smart device to participate. Do you have the ability to use a video camera on a smart device, computer or tablet?

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* 8. The telehealth programs expects you to participate in 6 sessions over 6 -8 weeks. Are you able to participate in 6 sessions over 6 - 8 weeks?

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* 9. The telehealth program requires participants to complete surveys after each telehealth visit,  one at the 7 month period and one at the 13 month after the education. Will you be able to complete these two surveys?

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* 10. What timezone are you in? 

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* 11. What is the best time to contact you  by phone?

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* 12. By checking the box below, you agree that you understand your information will be added to the Allergy and Asthma Network's database. Allergy and Asthma Network may contact you about upcoming studies. You may contact Allergy and Asthma Network at research@allergyandasthmanetwork.org to remove yourself from the database at any time.

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* 13. By checking the checkbox below, you confirm that you are  18 years old and that you may or may not be contacted for this specific study depending on the enrollment and other study factors.

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