Welcome to the online screening questionnaire for the Partner2Lose study

The purpose of this online screener is to see if you qualify for this study. If you meet these requirements, you will be asked to schedule an in-person appointment. If you are enrolled into the study you will be scheduled to attend group classes every two weeks for the first six months of the study, beginning in September 2019.

In this questionnaire, we will ask you to share some personal information. The online screener will ask you questions about your past and present health conditions, medications you are taking, alcohol and drug use, and your partner’s health. You will need to provide your first and last name, e-mail, age, and birth sex. If you are eligible, you will need to provide your complete contact information (address, phone and email) and your partner’s first and last name, e-mail, address and phone number so that they can be sent a link to complete their own online screener. You may also be asked for your complete contact information (address, phone and email) if you would like to be re-contacted about the study in the future.

Your responses will be kept confidential. Your personal information and responses are protected by the UW School of Medicine and Public Health firewalls and accessible only to research team members. Your information will be securely stored for up to 7 years after the study is complete, whether or not you qualify for the study.

If you are ineligible or decide not to participate, your age, birth sex, and information about why you were ineligible or declined to participate will be saved for up to 7 years after the study is complete. None of your personal information will be kept if you are ineligible or decide not to participate.

Completing this screening and participating in this study is voluntary. You can stop answering any questions at any time. Your refusal to answer questions will not negatively affect any relationship you have with UW-Madison.

If you have any questions, please contact the research team at (608) 890-2917 or partner2lose@surgery.wisc.edu.