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  2. 2006
  3. August
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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 stricly 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.
 
 
Do you know someone with epilepsy?
*  
Yes No
 
 
Is this person/s a member of your family?
*  
Yes No
 
 
Have you experienced someone having a seizure?
 
Yes No
 
 
How would you rate your understanding of Epilepsy?
*  
Excellent Good Average Below Average Poor
 
 
How common do you think Epilepsy is?
 
1. Very Common 2.Common 3. Rare 4. Don't know
 
 
Do you see Epilepsy as a physical or mental condition?
*  
1. Physical 2. Mental 3. Both 4. Don’t know
 
 
Do you feel there is sufficient information about Epilepsy available?

 
Yes No
 
 
 
Favorite Drink...
 
Coke
 
Pepsi
 
Sprite
 
Mountain Dew
 
A&W Root Beer
 
 
 
Additional Comments/Suggestions for improvement
   
 
Please contact [email protected] if you have any questions regarding this survey.
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