WORD OF MOUTH SURVEY - INFORMED CONSENT STATEMENT

The Centers for Disease Control and Prevention (CDC) and ICF, a consulting company, are conducting a health survey. The CDC is partnering with HealthTalker, LLC, and Voces Latinas to explore what the public knows about the Zika virus and the precautions you can take to reduce the chance of getting Zika when traveling. We will use this information for future communications.

You are being asked to participate. This survey should take about 10 minutes. A final report will be prepared for CDC with the results. Before you agree, please consider these conditions:

• Participation in this survey is completely voluntary. You may choose not to answer any questions, or stop the survey at any time.

• You can ask staff from Voces Latinas any questions about this project before or after completing the survey.

• You can also email the project team (Steve Simcox at steve@healthtalker.com or Bethany Tennant at bethany.tennant@icf.com) before or after completing the survey.

• Staff from ICF, CDC, HealthTalker, LLC, and Voces Latinas may review your survey responses as they put everyone’s results together.

• Your responses will not be associated with your name or email address. Your name will not be used in the report.

• You may stop answering the survey at any time.

* Do you agree to the above terms? By clicking Yes, you consent that you are willing to answer the questions in this survey.

Contact Information: If you have any concerns about your participation in this survey or about the project, please contact Steve Simcox at steve@healthtalker.com or Bethany Tennant at bethany.tennant@icf.com.
 

T