PFAS Questionnaire

Household members must live at the listed address in Richmond County of Augusta, Georgia for more than 180 days (6 months) in a year.
The participant, who records information and is the contact person for their family unit, needs to be 18 years old or older.

PFAS Qualification Questionnaire

First Name *

First

Last Name

Last

Email Address

Phone Number

Street Address

City

County

State

Zip Code

Are you willing to receive text messages and communications related to this study via text message.

Do you live at an address in Richmond County in Augusta, Georgia for at least 180 days (6 months) in a year?

Yes

How many members are in your family as defined by the study?

Are you interested in being considered for this study?

Yes

Not sure

How old are?

How many times did you eat with other members at home every week?

Anything else you would like to add.

If you are human, leave this field blank.