Code for the User: First Name: Last Name: Primary Phone: Secondary Phone: Email: When did you undergo gamete (sperm, egg) or embryo donation? 1st donation time (year): 2nd donation time(year): 3rd donation time (year): Are you a single parent or do you have a partner? Single No Maybe List other parenting arrangement: What is the age of your children? 1st child age: 2nd child age: 3rd child age: 4th child age: 5th child age: What is your primary language? English Spanish (Ineligible) Other (Ineligible) List other language: Do you live in the United States? Yes No (Ineligible) Do you have access to a computer that allows you to use the Internet? Yes No (Ineligible) How did you find about this study? Announcement or Advertisement posted on a Website, Facebook page, or other Social Media Nurse or Physician recommended it Psychologist or Other Counselor recommended it Friend or Family Member recommended it I found it on my own while searching the Internet Other Eligible for study? Yes No Screening notes: Does this participant have a partner that has already been randomized? Enter partner’s randomization id: Oldest child’s age category: 13 to 16 years old 8 to 12 years old 1 to 7 years old Submitted Error. Please try again Share this:TwitterFacebookLike this:Like Loading...
