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Hello:
You are invited to participate in our survey [Project Description Here]. In this survey, approximately [Approximate Respondents] people will be asked to complete a survey that asks questions about [General Survey Process]. It will take approximately [Approximate Time] minutes to complete the questionnaire.

Your participation in this study is completely voluntary. There are no foreseeable risks associated with this project. However, if you feel uncomfortable answering any questions, you can withdraw from the survey at any point. It is very important for us to learn your opinions.

Your survey responses will be strictly confidential and data from this research will be reported only in the aggregate. Your information will be coded and will remain confidential. If you have questions at any time about the survey or the procedures, you may contact [Name of Survey Researcher] at [Phone Number] or by email at the email address specified below.

Thank you very much for your time and support. Please start with the survey now by clicking on the Continue button below.

 
 
 
 
1. Are you a woman?
 
Yes
 
No
 
 
 
What is your date of birth?
 
 
 
4. Do you have epilepsy/seizure disorder?
 
Yes
 
No
 
 
 
5. What is the ethnicity with which you MOST CLOSELY identify? (check only one):
 
Hispanic or Latina
 
Not Hispanic or Latina
 
 
 
6. With which race do you MOST CLOSELY identify? (check only one)
 
American Indian or Alaska Native
 
Native Hawaiian or Other Pacific Islander
 
Asian
 
White
 
Black or African-American
 
 
 
7. What is the highest level of school you have completed?

 
Less than High School
 
High School
 
Some College
 
Associate’s Degree
 
Bachelor’s Degree
 
Advanced Degree
 
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