8a - Dietary recall scheduling

Salt Sources Study Dietary Recall Scheduling Form

Note to Clinic coordinator: Please complete this form for each participant. Email completed form to Mary Austin at NCC ([email protected], [email protected], [email protected]).

Participant ID: Sub Study Non-Sub Study (circle one)

Participant Name: Sex: male female (circle one)

first and last

Recall 1

Date: / /

month date year

Time: am/ pm (circle one) CT/ PT (circle one)

Phone number: home/ cell/ work/ other (circle one)

Recall 2

Date: / /

month date year

Time: am/ pm (circle one) CT/ PT (circle one)

Phone number: home/ cell/ work/ other (circle one)

Recall 3

Date: / /

month date year

Time: am/ pm (circle one) CT/ PT (circle one)

Phone number: home/ cell/ work/ other (circle one)

Recall 4

Date: / /

month date year

Time: am/ pm (circle one) CT/ PT (circle one)

Phone number: home/ cell/ work/ other (circle one)

Any special instructions/notes: