TTACHMENT D: INFORMED CONSENT
ICF International (ICF) is conducting a web-based survey to hear your input on CDC’s HEADS UP concussion education campaign. We value your feedback and thank you for taking the time to complete this survey.
The survey should take no more than 15 minutes to complete. A report of the results from the survey will be prepared by ICF for CDC. Before you agree to join in this discussion, please review and consider the conditions listed below:
Participation in this survey is completely voluntary.
If you have any questions about this survey, please send them to: Rosanne Hoffman, [email protected], 301-407-6596.
Your name, and/or any other personally identifiable information will not be used in any reports.
You may choose not to answer questions that you do not want to answer.
You may choose to leave the survey at any time for any reason.
This survey is authorized under Section 301 of the Public Health Service Act, (42 U.SC.241) authorized on December 31, 2004.
Your signature below indicates that you understand the conditions stated above and agree to participate in this survey.
Name: ___________________________
Signature _______________________________________
Date _______________________________________
| File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
| Author | Donnell, Zoe |
| File Modified | 0000-00-00 |
| File Created | 2021-01-27 |