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:

xyZGCSavwgaHftsAqANv8gQmvSFeVfKYjZ6fTqDRYGkU3Ep

COVID-19 Study: Interest Form

The Keck School of Medicine of USC is studying how the COVID-19 pandemic is impacting physical activity and mental health in U.S. adults. We are interested in studying both (1) adults who are healthy, and (2) adults who have been diagnosed with COVID-19. This survey will take about 30 min, and we will ask you to download an app. In 6-12 months, we'll ask you to fill out another 30-min survey. You'll have a chance of winning an Amazon gift card.

Thank you for taking the time to help us better understand this pandemic.

Please fill out the form below.

If you have questions, please email reachcovid@gmail.com

Are you 18 years or older?

* must provide value

Yes

reset

Do you speak English?

* must provide value

Yes

reset

Do you live in the United States of America?

* must provide value

Yes

reset

Do you own and regularly use an Android or iPhone smartphone?

* must provide value

Yes

reset

Does your smartphone have the capability to run mobile applications downloaded from the corresponding application store (either App store or Google Play)?

* must provide value

Yes

Do not know

reset

Are you willing to download a free application from the mobile application store to use for the duration of the study (~4 weeks)?

* must provide value

Yes

reset

Are you willing to comply with all of the study protocol, including:

1) Completing the consenting process;

2) Completing baseline electronic surveys about your health and physical activity;

3) Completing 2 surveys per day on your smartphone for the duration of the study; and

4) Completing follow-up electronic surveys about your health and physical activity?

* must provide value

Yes

reset

Are you currently participating in another research study examining your physical activity behaviors, such as wearing a physical activity measurement device, participating in a physical activity intervention, etc.?

* must provide value

Yes

reset

Please explain the study you are participating in:

* must provide value

Expand

What is your email address?

Note: We will only use your email address to send you surveys and instructions about this study.

* must provide value

How did you find out about this study?

Social Media/Ad

Recruitment Email/List-serv

Word of Mouth

reset

If you not eligible for this study, do you give us permission to contact you in the future for other research studies?

Yes

reset

Screening Survey Sum

* must provide value

View equation

Does the participant qualify for the study based on the screening questions?

* must provide value

View equation

Screening form completion date

* must provide value

M-D-Y

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.