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

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Required format:

Trust and Respect in Birth Control Experiences: Eligibility And Screening Form

Hi! Thank you for your interest in our project! Please complete the 5-minute survey below to see if you are eligible to participate.

If you have questions or concerns, you can contact us:

PPMNS Research
research@ppmns.org
651-389-2387

Please complete the questionnaire below to determine if you are eligible to participate.

Are you between 18 and 45 years old?

* must provide value

Yes

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Based on your answers, you are not eligible to participate in the Trust and Respect Birth Control Project.

If you have answered questions incorrectly, you can go back and change your answers.

Please push "Submit" to exit the survey.

Thank you for your time and please tell interested friends and family about the study!

Do you speak English?

* must provide value

Yes

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Do you identify as a person of color?

* must provide value

Yes

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Have you had an abortion in the past 2 years?

* must provide value

Yes

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Are you currently pregnant?

* must provide value

Yes

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Are you located in the Twin Cities Metro area?

* must provide value

Yes

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Are you able and willing to consent to a recorded zoom interview?

* must provide value

Yes

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Are you able and willing to consent to your interview being used to create publicly available educational
materials such as videos, handouts, and presentations?

* must provide value

Yes

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You are eligible to participate in the Trust and Respect Birth Control Project!

Please continue with the contact information and scheduling questions below so we can get in touch!

Name (You may use your first name only or a fake name)

* must provide value

What is your gender? (Ex: "woman", "trans man", "genderqueer", etc.)

What are your gender pronouns? (Example: "she/her", "they/them", etc.

* must provide value

What is your email address?

* must provide value

What is your phone number?

* must provide value

Can we call and leave a voicemail identifying us a Planned Parenthood Research?

* must provide value

Yes

No. Please contact me via email only.

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Which of the following dates and times are you generally available for an interview? Your visit should take about 2 hours.

* must provide value

Saturday mornings

Saturday afternoons

Sunday mornings

Sunday afternoons

Please tell us more about when you would be available in the next month.

* must provide value

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Do you need any of the following accommodations to participate?

Note: We cannot guarantee that assistance for child care or transportation will be provided.

* must provide value

Child care or dependent care

Transportation assistance

Disability accommodations

Other accommodations

No. I don't need any accommodations to participate.

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Please tell us more about what accommodations you will need.

* must provide value

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Is there anything else you'd like us to know?

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Thank you for completing this important first step!

A researcher will be in touch with you within 7-10 days to schedule an interview.

If you have questions or concerns, you can contact us:

PPMNS Research
research@ppncs.org

Please push "Submit" to finish the survey.

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.