Att 5c - Advance FAX

Attachment 5C

Advance Fax for Provider Survey

Advance Fax

Insert Date

Name

Title

Address

City, State, Zip

Dear Insert Name:

As you know, the Centers for Disease Control and Prevention (CDC) is a federal agency that conducts a broad range of public health research and disease monitoring. This fax is to request your assistance with the CDC in an important area – screening for colorectal cancer. The CDC has contracted with ICF Macro, an independent survey research firm, to conduct a study of physicians and their experiences, practices, and opinions regarding colorectal cancer testing.

Using standard sampling techniques, we have selected a group of primary care physicians from several areas around the country to participate in a written survey. In the next few days, you will receive a Priority Mail package from us containing the survey and a postage-paid return envelope. We recognize that your time is extremely valuable. As a small token of our appreciation we are including a $25 money order in the package.

If you participate in this study, we will protect your identity and privacy. Your name will not be associated with any written report. Responses to survey items will have no identifiers other than a master identification number. This fax number and your contact information will be stored by CDC’s contractor, ICF Macro, in a file with restricted access. The database with your responses will be separate from the file with your contact information. At the end of the study, any and all linked information will be destroyed.

Your opinions, along with those of other physician participants, will be compiled and summarized by ICF Macro. These summaries will be given to the CDC to help us better shape our colorectal cancer screening promotional efforts. Your opinions, and those of other practicing doctors, are especially important to these efforts.

If you have any questions about this study, you may contact me at CDC (insert toll free number), or Michelle Revels, the Study Director at ICF (insert toll free number). If you have questions about this specific fax, or if you wish to be removed from receiving future faxes from ICF Macro’s Call Center, please call 1-(insert toll free number) If you wish to have your fax number removed from the AMA’s Physician FAX Database, call 1-800-621-8335.

Please look out for the Priority Mail package coming to you in the next few days. We would appreciate you completing and returning the survey as soon as you can. We sincerely hope you will choose to participate and help us better understand the attitudes and practices of physicians regarding colorectal cancer screening.

Again, thank you for your time!

Sincerely,

Amy DeGroff, PhD, MPH, Division of Cancer Prevention and Control

National Center for Chronic Disease Prevention and Health Promotion

Centers for Disease Control and Prevention