Strategies To Respond to Intimate Violence Effectively (STRIVE)

Contact Information Form

Thank you for taking the STRIVE survey! Please fill out the information below so we can send you a $10 gift card to thank you for your participation.

You can choose to get the gift card link by text or email:

Text: The link will come from [PHONE NUMBER].

Email: The link will come from [EMAIL ADDRESS].

Your Information:

First Name:
Last Name:
Phone Number:
Email:

How would you like to get your gift card link?

• Phone

• Email

[Ask at pre-intervention only] Is it ok for the STRIVE study team to reach out to you using the contact information you provided to remind you about your next survey?

• Yes

• No

You will get your gift card link within 5 days of finishing the survey. If you don’t receive it or have any trouble using it, please contact the study team at [PHONE NUMBER] or [EMAIL ADDRESS].

Thank you for being a part of the STRIVE study!