Contact Information

The code block below illustrates how one might use # and // as comments in your logic and calculations.

This value you provided is not a number. Please try again.

This value you provided is not an integer. Please try again.

The value entered is not a valid Vanderbilt Medical Record Number (i.e. 4- to 9-digit number, excluding leading zeros). Please try again.

The value you provided must be within the suggested range

The value you provided is outside the suggested range

This value is admissible, but you may wish to double check it.

The value entered must be a time value in the following format HH:MM within the range 00:00-23:59 (e.g., 04:32 or 23:19).

This field must be a 5 or 9 digit U.S. ZIP Code (like 94043). Please re-enter it now.

This field must be a 10 digit U.S. phone number (like 415 555 1212). Please re-enter it now.

This field must be a valid email address (like joe@user.com). Please re-enter it now.

The value you provided could not be validated because it does not follow the expected format. Please try again.

Required format:

SALXirEeDwr7jEnuLenYsm3d3aombxmaSJ5JC4bzcm5oJcAYzgV62uy7sAvszoFkA882ZQDsiKn9pxsZsApFATndMdrImv6Xc9ifTNf3HxAwVf9utVbdvL

Thank you for your interest in the HOPE study. Your participation could help uncover ways to help women and infants worldwide.

This questionnaire collects your contact information. The information in this survey is critical for staying in contact with you and will be used to send you a consent to participate in the study and all subsequent surveys.

All required fields are indicated with an “*”. This information is kept separately from all other study related data. Your information is kept on protected computers behind security walls at the University of California San Francisco.

You will be asked at each HOPE survey time point if any of this information has changed and you will be asked to update it. You can also contact us with any changes at hope_@ucsf.edu.

If you have additional questions before enrolling please contact us at: Hope@UCSF.edu. Thank you again for your interest.

The HOPE Study Team

Consent type:

(this field is hidden)

* must provide value

Biospecimen

Surveys only

reset

To qualify for the Survey+Testing arm of the study you must:

1) be pregnant
2) be 18-years of age or older
3) feel comfortable, willing and able to download applications onto your mobile phone as part of the study
4) feel comfortable reading and writing in English
5) feel comfortable having nasal swab and blood specimens collected in your home or at a laboratory facility in San Francisco or Novato during scheduled collection periods (at enrollment, in subsequent trimesters, and at 6-8 weeks after birth))
6) feel comfortable with releasing your medical records for study review
7) live in San Francisco, Marin, Sonoma, Napa, Solano, Contra Costa, Alameda, Santa Clara or San Mateo counties in California

If 1-7 above are true for you, please enter your contact information below and we will send you your study consent form and then your first set of surveys.

To qualify for the survey-only arm of the study you must:

1) be pregnant
2) be 18-years of age or older
3) feel comfortable, willing and able to download applications onto your mobile phone as part of the study
4) feel comfortable reading and writing in English.

If 1-4 above are true for you, please enter your contact information below and we will send you your study consent form and then your first set of surveys.

What is your full name:

First:

* must provide value

Middle:

Last:

* must provide value

What is your date of birth:

* must provide value

M-D-Y

Have you been a participant in the HOPE study with a previous pregnancy?

Yes

reset

Which arm of the HOPE study did you participate in?

Survey only

Survey+testing

I don't remember

reset

When was your baby born (please provide the birth date of your baby previously enrolled in HOPE)?

D-M-Y

Do you live in the United States?

Yes

reset

What is your current living address?
City:

* must provide value

Country:

* must provide value

Are you currently homeless?

* must provide value

Yes

reset

What is your current living address?
Street Address:

* must provide value

Expand

City:

* must provide value

State:

* must provide value

Zip code:

* must provide value

Please provide an address where you receive mail and packages:

Expand

City:

State:

Zip code:

What is your current mobile phone number (should be the phone you plan to upload study mobile applications to):

* must provide value

Alternate phone number:

What is your email address (should be the email address you plan to receive study emails at):

* must provide value

Alternate email address:

Is there a family contact we can use to contact you if we are having trouble getting ahold of you using the contact information above?

Yes

reset

Name:

Address:

Expand

Mobile phone number:

Email address:

How did you hear about the HOPE Study? (check all that apply)

Friends/family

Twitter

Facebook

Instagram

Health care provider, clinic, hospital

News story

Other

What other way did you hear about the HOPE Study?

You have selected an option that triggers this survey to end right now.

To save your responses and end the survey, click the 'End Survey' button below. If you have selected the wrong option by accident and/or wish to return to the survey, click the 'Return and Edit Response' button.