Consent Form
Thank you for helping us learn more about the health of the Latino community in Arizona!
You are participating because you identify as Hispanic/Latine, live in Arizona, and are at least 18 years old.
The purpose of this health questionnaire is for both of us to learn more about your health. We will ask you questions about your mood, health factors, stress, and some demographic questions.
All your responses are anonymous and you can stop completing the health screener at any time and without penalty.
It will only take you about 9-12 minutes to fill out this questionnaire.
By completing the health questionnaire, you will receive your score and recommendations based on your score. We will also give you a list of health providers if you would like to access mental health services or receive emotional support.
We want at least 250 people to fill out our health screener.
Upon completion of the health screener you can participate in a free drawing in which you could win 1 of 15 Amazon $10 gift cards.
If you have questions, concerns, or complaints, you can contact Dr. Capielo Rosario at ccapielo@asu.edu or by calling 786.566.7191.
This health screener has been reviewed and approved by the Institutional Review Board of Arizona State University. You can talk to them at 480.965.6788 or by email, research.integrity@asu.edu.
By clicking on the button that says Next, you are agreeing to be part of the study.