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Welcome to the screening questions for the Log2Lose study
This study is taking place at the University of Wisconsin Madison (UW-Madison) and Duke University.
The purpose of answering the screening questions is to see if you qualify for this study. These questions make sure that the people who participate in the Log2Lose study are able to do so as safely as possible. Please read these questions carefully and answer them the best you can. Doing so will make sure you can safely participate.
We will ask you to share some personal information, including questions about your past and present health conditions, medications you are taking, and alcohol and drug use. You will need to provide your first and last name, e-mail, age, race, ethnicity, and birth sex. You may also be asked for your complete contact information (address, phone and email) if you would like to be re-contacted about the study in the future.
Your responses will be kept private. Your personal information and responses are stored on secure servers that sit behind a firewall at Duke University. Your information is only available to members on the research team who have approval to view this information.
If you enroll in the study, all information you provide will be securely stored for up to 7 years after the study is complete. If you do not qualify, or decide not to participate, your age, birth sex, race, ethnicity, and information about why you did not qualify or why you declined to participate will be saved for up to 7 years after the study is complete; however, no identifying information such as your name or email address will be kept.
Completing the screening questions and participating in this study are voluntary. You can stop answering any questions at any time. Your refusal to answer questions will not negatively affect any relationship you have with UW-Madison or Duke University.
If you have any questions, please contact the Duke University research team at log2lose@duke.edu or the UW-Madison research team at log2lose@surgery.wisc.edu.
Please select the location that is closest to you:
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North Carolina (Duke University)
Wisconsin (University of Wisconsin-Madison)
years
First Name
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Last Name
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Birth Sex
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Male Female
The option " " can only be selected by itself. Selecting this option will clear your previous selections for this checkbox field. Are you sure?
How would you describe your race? Please indicate all that apply.
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American Indian or Alaska Native
Asian
Black or African American
Native Hawaiian or Other Pacific Islander
White
Decline to answer
Do you have an email address?
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Yes No
Email AddressPlease note: Your email address will only be used to contact you regarding the Log2Lose study
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How did you find us
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Received letter in the mail
Flyer or poster I saw posted in community
Flyer or poster I saw posted at my doctor's office
Received email
Referred by my clinic/doctor
Facebook ad
Instagram ad
Newspaper/newsletter
Saw interview on local news
From friend/family/previous study participant
ClinicalTrials.gov
Other
Where did you see the flyer or poster in your community?
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Which newspaper/newsletter?
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Other
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How did you find us? (select all that apply)
ClinicalTrials.gov website
ClinicalTrials.gov website
Duke Clinical Trials website
Duke Clinical Trials website
UW Health website
Referred by my doctor/clinic
Referred by my doctor/clinic
MyChart
Presentation
Where?
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Where?
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Direct communication from Log2Lose team
Direct communication from Log2Lose team
Direct communication from Log2Lose team
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Email about the study
Letter in the mail from the study team
Conversation with study team member
Flyer or Poster I saw
Where?
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At my doctor's office or in a clinic
In the community (e.g., library, grocery store, etc.)
In my church or social group gathering place
Other
Specify other location
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Specify other
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TV or Radio
Advertisement
News story about the study
Newspaper / Newsletter
Instagram Ad
Community or Religious Organization (e.g., AME Zion Church)
Community or Religious Organization (e.g., AME Zion Church)
Which one?
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Word of Mouth: friend/family/previous study participant (e.g., text, email, conversation)
Word of Mouth: friend/family/previous study participant (e.g., text, email, conversation)
Facebook
Facebook how
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Facebook ad
Facebook group post
Facebook friend post
Other Social Media (e.g., Reddit, Craigslist, Dukelist, etc.)
Other Social Media (e.g., Reddit, Craigslist, Dukelist, etc.)
Social media how
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Reddit
Craigslist
Duke List
Twitter
ResearchMatch
Online article
Which publication
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Madison 365
La Comunidad
Other
Specify other publication
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Other
Specify Other
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By checking the box, you are agreeing that you have read all of the information provided above and are willing to proceed with the online screening questions.
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I have read the information and am willing to proceed with the online screening questions.
I have read the information and am NOT willing to proceed with the online screening questions.
Submit
Save & Return Later
Yes, I am available
No, I am not available
Yes, I am available
No, I am not available