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Hello:
You are invited to participate in our survey [Project Description Here]. In this survey, approximately [Approximate Respondents] people will be asked to complete a survey that asks questions about [General Survey Process]. It will take approximately [Approximate Time] minutes to complete the questionnaire.

Your participation in this study is completely voluntary. There are no foreseeable risks associated with this project. However, if you feel uncomfortable answering any questions, you can withdraw from the survey at any point. It is very important for us to learn your opinions.

Your survey responses will be strictly confidential and data from this research will be reported only in the aggregate. Your information will be coded and will remain confidential. If you have questions at any time about the survey or the procedures, you may contact [Name of Survey Researcher] at [Phone Number] or by email at the email address specified below.

Thank you very much for your time and support. Please start with the survey now by clicking on the Continue button below.

 
 
 
Gender
 
Male
 
Female
 
Other
 
 
 
 
Are you pregnant
 
Yes
 
No
 
Not Sure
 
 
 
Marital Status
 
Child
 
Divorced
 
Domestic Partner
 
Married
 
Separated
 
Single
 
Unspecified

 
 
 
Relation
 
Self
 
Spouse
 
Family Member
 
Friend
 
 
 
Ethnicity
 
Hispanic/Latino
 
Non-Hispanic/Latino
 
Unspecified
 
Other
 

 
 
 
What types of credit cards do you have (Select all that apply)?
 
Visa
 
Mastercard
 
American Express
 
Discover
 
Diners Club