Response Card

Attachment 3.b - Response Card

Front:

Study to Explore Early Development (SEED) Teen Follow-up Study

SEED Teen

CDC and HHS Logos and/or Site Institution Logo

Picture

Back:

<site specific source code>

We hope you and your child will take part in SEED Teen!

We will call you in a couple of weeks to discuss the study with you. If any of your contact information has changed since you took part in SEED, please let us know how to reach you. You are under no obligation to take part in this study if you contact us.

Complete the following information and mail this card to us in the pre-paid envelope.

Name: ____________________________

Address: __________________________ Telephone numbers

_________________________________ Home Phone __________________________

_________________________________ Cell Phone __________________________

Email: ___________________________ Other Phone __________________________

I prefer to be reached by (circle one): Best time to reach me is (circle one):

Telephone E-mail Morning Afternoon Early Evening

OR

If you prefer, you can contact us.

• by phone at <number>,

• by text at <number>,

• by emailing us at <email address>.

If you text or email us, give us your name and a telephone number or email address where we can reach you.

Version Jan 2017 2