Contact Form

Please complete this brief form if you would like to receive more information about the study or sign up for it. All information provided is confidential and will not be shared with any third parties. There are no expected risks or harms associated with the completion of this form and the participant recruitment process for this study has been approved by Acadia University's Ethics Review Board. If you have any questions or concerns, please feel free to contact me by email.

What is Your Gender?

Male

Female

Other:

How Old Are You?

18 to 24

25 to 34

Over 35

What is Your Sexual Orientation?

Homosexual

Heterosexual

Bisexual

Other:

What is Your Relationship Status?

Dating

Cohabiting

Engaged

Married

Single

Other:

Would you be willing to participate in a 2 year longitudinal study on relationships & health? Participation would occur approx. every 6 months, online.

Yes No

If you are in a relationship, would your partner be willing to participate in the study as well?

Yes No

Do you have any questions, comments or concerns?

How did you hear about this study / website? (more than one answer can be selected using the 'ctrl' key).

Name (Or, if preferred, an alias):

City:

State/Province:

Country:

Zip/Postal Code:

Phone:

Email:

* Required Fields

** We ask for your contact information so that we will be able to provide you with more information about the study. We are asking you for your location information only to determine the various geographic regions participants are from. If you are uncomfortable providing detailed information, please at least give us your state/province and country so that we can determine a general distribution of geographic regions. Your Email will be our primary method of contacting you; the telephone will only be used as a back up. For your name, feel free to enter your real name or an alias.

If at any time you wish to stop receiving information or e-mails about the study, or drop out of the study, simply email us and we will remove you from our participant mailing list.

Information provided in this form will not be shared with any other third party. For more information on the confidentiality of your participation, please refer to our privacy policy.

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