This survey can have up to 25 questions that open based on your responses. Please complete all sections before submitting.
Thank you!
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?
ie. She/her, they/them, he/him, xe/xir
What month were you born?
January
February
March
April
May
June
July
August
September
October
November
December
What age range are you in?
* must provide value
Below 18
18-34
35-49
50+
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.
Yes, I would like to be contacted for future studies I may be eligible for.
No I would not like to be contacted for future studies.
Do you have a uterus?
* must provide value
No
Yes
What is your current gender identity?
* must provide value
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.
Yes, I would like to be contacted for future studies I may be eligible for.
No I would not like to be contacted for future studies.
Do you identify as Black or African American?
* must provide value
Yes
No
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.
Yes, I would like to be contacted for future studies I may be eligible for.
No I would not like to be contacted for future studies.
Have you ever experienced heavy periods lasting more than 7 days with your cycle?
* must provide value
Yes
No
Have you ever experienced Irregular or changing timing of your cycle ?
* must provide value
Yes
No
Have you ever experienced spotting in-between periods?
* must provide value
Yes
No
Have you ever required blood transfusions to manage your cycle?
* must provide value
Yes
No
Have you ever experienced bleeding that concerned you or your doctor?
* must provide value
Yes
No
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.
Yes, I would like to be contacted for future studies I may be eligible for.
No I would not like to be contacted for future studies.
Would you identify with being before, in the middle of, or after the menopause transition?
* must provide value
Before menopause
Currently in menopause
After menopause
Menopause can be characterized by no longer having spontaneous cycles due to age or medication
Have you had a complete or partial hysterectomy?
* must provide value
Yes
No
Hysterectomy is a procedure where part of or all of your uterus or womb has been removed.
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.
Yes, I would like to be contacted for future studies I may be eligible for.
No I would not like to be contacted for future studies.
is prior hyst a screen fail?
Have you ever been diagnosed with endometrial (uterine) cancer?
* must provide value
Yes
No
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.
Yes, I would like to be contacted for future studies I may be eligible for.
No I would not like to be contacted for future studies.
Are you currently incarcerated or in a detention facility?
* must provide value
Yes
No
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.
Yes, I would like to be contacted for future studies I may be eligible for.
No I would not like to be contacted for future studies.
Are you comfortable speaking, listening and reading English on your own?
* must provide value
Yes
No
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.
Yes, I would like to be contacted for future studies I may be eligible for.
No I would not like to be contacted for future studies.
Are you located in the United States or a U.S. Territory?
* must provide value
Yes
No
Location is based on primary residence.
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.
Yes, I would like to be contacted for future studies I may be eligible for.
No I would not like to be contacted for future studies.
Are you located in North Carolina?
* must provide value
Yes
No
Are you local to Charlotte, NC?
* must provide value
Yes
No
If you are not able to attend in person focus groups, you may still be eligible to attend a virtual focus group.
Are you available on Friday June 9, 2023 at 6 pm?
No
Yes
Are you local to Durham, NC?
* must provide value
Yes
No
If you are not able to attend in person focus groups, you may still be eligible to attend a virtual focus group.
Are you available on Saturday June 10, 2023 at 11 am?
* must provide value
No
Yes
Where are you located? (city, state)
* must provide value
Can we contact you via phone to share details of the focus group (meeting time, location, etc.)?
* must provide value
Yes
No
Phone number
* must provide value
Can we leave a message on your phone?
* must provide value
Yes
No
Can we text you?
* must provide value
Yes
No
Can we contact you via email to share details of the focus group (meeting time, location, etc.)?
* must provide value
Yes
No
What is your email address?
* must provide value
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.
I am no longer interested
You've indicated that you no longer are interested in the focus groups and do not want to be contacted. You can exit now or select submit and we will remove information you selected on our end. Thank you for your time and interest.
Can we contact you for other study opportunities?
* must provide value
Yes
No
Please hit submit to save your responses.
Can we contact you via phone to share details of opportunities to participate in future studies or discussions?
* must provide value
Yes
No
Phone number
* must provide value
Can we leave a message on your phone?
* must provide value
Yes
No
Can we text you?
* must provide value
Yes
No
Can we contact you via email to share details of opportunities to participate in future studies or discussions?
* must provide value
Yes
No
What is your email address?
* must provide value
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.
I am no longer interested
You've indicated that you no longer are interested in being contacted for other studies. You can exit now or select submit and we will remove information you selected on our end. Thank you for your time and interest.
Please enter any notes or information you want to share with us. When you are finished, please select submit.