Black women's gynecologic health focus groups

First Name

A pronoun is a word that you use to refer to someone or something when you do not need to use a noun, often because the person or thing has been mentioned earlier. Examples are 'they', 'she', 'something', and 'myself'.' How do you like to be referred to? What are your pronouns?

What month were you born?

What year were you born?

Thank you for your responses. Unfortunately, one of your responses indicates you are not eligible for participation. We appreciate your time and interest. This form does not automatically store your name or information you provide unless you select "Submit."

If you would like to be contacted in future for studies you may be eligible for, please select accordingly, enter in your contact information and click the submit button.

If you do not want to be contacted for future studies, you can (1) select no and submit. We will delete the information you entered on our end. Or (2) You can simply exit the form and your information will not be saved.

Do you have a uterus?

What is your current gender identity?

Thank you for your responses. Unfortunately, one of your responses indicates you are not eligible for participation. We appreciate your time and interest. This form does not automatically store your name or information you provide unless you select "Submit."

If you would like to be contacted in future for studies you may be eligible for, please select accordingly, enter in your contact information and click the submit button.

If you do not want to be contacted for future studies, you can (1) select no and submit. We will delete the information you entered on our end. Or (2) You can simply exit the form and your information will not be saved.

Do you identify as Black or African American?

Thank you for your responses. Unfortunately, one of your responses indicates you are not eligible for participation. We appreciate your time and interest. This form does not automatically store your name or information you provide unless you select "Submit."

If you would like to be contacted in future for studies you may be eligible for, please select accordingly, enter in your contact information and click the submit button.

If you do not want to be contacted for future studies, you can (1) select no and submit. We will delete the information you entered on our end. Or (2) You can simply exit the form and your information will not be saved.

Have you ever experienced heavy periods lasting more than 7 days with your cycle?

Have you ever experienced Irregular or changing timing of your cycle ?

Have you ever experienced spotting in-between periods?

Have you ever required blood transfusions to manage your cycle?

Have you ever experienced bleeding that concerned you or your doctor?

Thank you for your responses. Unfortunately, one of your responses indicates you are not eligible for participation. We appreciate your time and interest. This form does not automatically store your name or information you provide unless you select "Submit."

If you would like to be contacted in future for studies you may be eligible for, please select accordingly, enter in your contact information and click the submit button.

If you do not want to be contacted for future studies, you can (1) select no and submit. We will delete the information you entered on our end. Or (2) You can simply exit the form and your information will not be saved.

Would you identify with being before, in the middle of, or after the menopause transition?

Have you had a complete or partial hysterectomy?

Thank you for your responses. Unfortunately, one of your responses indicates you are not eligible for participation. We appreciate your time and interest. This form does not automatically store your name or information you provide unless you select "Submit."

If you would like to be contacted in future for studies you may be eligible for, please select accordingly, enter in your contact information and click the submit button.

If you do not want to be contacted for future studies, you can (1) select no and submit. We will delete the information you entered on our end. Or (2) You can simply exit the form and your information will not be saved.

Have you ever been diagnosed with endometrial (uterine) cancer?

Thank you for your responses. Unfortunately, one of your responses indicates you are not eligible for participation. We appreciate your time and interest. This form does not automatically store your name or information you provide unless you select "Submit."

If you would like to be contacted in future for studies you may be eligible for, please select accordingly, enter in your contact information and click the submit button.

If you do not want to be contacted for future studies, you can (1) select no and submit. We will delete the information you entered on our end. Or (2) You can simply exit the form and your information will not be saved.

Are you currently incarcerated or in a detention facility?

Thank you for your responses. Unfortunately, one of your responses indicates you are not eligible for participation. We appreciate your time and interest. This form does not automatically store your name or information you provide unless you select "Submit."

If you would like to be contacted in future for studies you may be eligible for, please select accordingly, enter in your contact information and click the submit button.

If you do not want to be contacted for future studies, you can (1) select no and submit. We will delete the information you entered on our end. Or (2) You can simply exit the form and your information will not be saved.

Are you comfortable speaking, listening and reading English on your own?

Thank you for your responses. Unfortunately, one of your responses indicates you are not eligible for participation. We appreciate your time and interest. This form does not automatically store your name or information you provide unless you select "Submit."

If you would like to be contacted in future for studies you may be eligible for, please select accordingly, enter in your contact information and click the submit button.

If you do not want to be contacted for future studies, you can (1) select no and submit. We will delete the information you entered on our end. Or (2) You can simply exit the form and your information will not be saved.

Are you located in the United States or a U.S. Territory?

Thank you for your responses. Unfortunately, one of your responses indicates you are not eligible for participation. We appreciate your time and interest. This form does not automatically store your name or information you provide unless you select "Submit."

If you would like to be contacted in future for studies you may be eligible for, please select accordingly, enter in your contact information and click the submit button.

If you do not want to be contacted for future studies, you can (1) select no and submit. We will delete the information you entered on our end. Or (2) You can simply exit the form and your information will not be saved.

Are you located in North Carolina?

Are you local to Charlotte, NC?

Are you available on Friday June 9, 2023 at 6 pm?

Are you local to Durham, NC?

Are you available on Saturday June 10, 2023 at 11 am?

Where are you located? (city, state)

Can we contact you via phone to share details of the focus group (meeting time, location, etc.)?

Phone number

Can we leave a message on your phone?

Can we text you?

Can we contact you via email to share details of the focus group (meeting time, location, etc.)?

What is your email address?

You indicated no for both email and phone contact. In order for us to contact you, we need at least one method of contact. If you are interested, please update one of the responses and provide contact information. If you do not want to share your contact information or you are no longer interested in the focus group, please select accordingly below.

Can we contact you for other study opportunities?

Can we contact you via phone to share details of opportunities to participate in future studies or discussions?

Phone number

Can we leave a message on your phone?

Can we text you?

Can we contact you via email to share details of opportunities to participate in future studies or discussions?

What is your email address?

You indicated no for both email and phone contact. In order for us to contact you, we need at least one method of contact. If you are interested in being contacted for other study opportunities, please update one of the responses and provide contact information. If you do not want to share your contact information or you are no longer interested in potential other studies, please select accordingly.

Please enter any notes or information you want to share with us. When you are finished, please select submit.