Thank you for your interest in participating in this important project. We are working to improve how healthcare providers identify and support individuals who have experienced interpersonal or domestic violence.

We are inviting survivors to share their experiences in a confidential, one-hour interview. Your insights will help shape safer, more supportive healthcare practices. Participation is completely voluntary, and your privacy will be respected at all times.

If you are interested in learning more or would like to take part, please provide your preferred contact information below. A member of our team will reach out to you privately.

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* 1. What is your first and last name? You may use a pseudonym or nickname to protect your identity, if you prefer.

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* 2. What County do you live in?

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* 3. What is your phone number?

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* 4. What is your email?

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* 5. What is the best way to contact you?

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* 6. Is it okay to call you?

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* 7. Is it okay to text you?

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* 8. Is it okay to leave a voicemail?

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* 9. Interviews will take approximately one hour to complete. Do you have a preferred day or time that works best for you?

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