Consent Form

Attachment 6_EVALI Consent Form V2.docx

2019 Lung Injury Response Understanding Vaping Practices in the United States

Consent Form

OMB: 0920-1276

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Attachment 6. EVALI consent


We would like to include you as a participant in a survey about an important health issue. If you agree to be in this study, we will ask you your views and experiences with certain health issues. Participation is voluntary, and you may decline to answer any questions that you do not want to answer. The survey will take about 12 minutes to finish.

Do you consent to participate?

Ο Yes

Ο No

Understanding Vaping Practices in the U.S.

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File Typeapplication/vnd.openxmlformats-officedocument.wordprocessingml.document
AuthorDaugherty, Jill (CDC/DDNID/NCIPC/DIP)
File Modified0000-00-00
File Created2021-01-15

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