Forms

Fitbit Replacement Form

Update Phone Information Form

Compliance Issue Form

Consent Forms  – Tier 3

If after registering for the NetHealth Study you receive an email inviting you to be in the NetHealth study, you must complete and submit a consent form.  A link to a short survey will be sent to you through which you can submit the consent form.   Here is what you need to do:

Download the Tier 3 Consent Form.  If you are under 18 years old, please email nethealth@nd.edu and we will provide an under 18 assent form and a parental consent form that you can download.

Carefully read over the consent form, fill in the information requested on the last page, and sign and date the consent form.

Take a picture with your phone of the last page (the page that you signed) and attach that picture as instructed to do so in the survey you received.  You do not have to attach copies of all the pages of the consent form, just a copy of the last signed page.

pdfNetHealth Over 18  Tier 3 Consent Form
Download File

Consent Forms – Tiers 1 and 2

First, please download and complete the correct form(s) depending on your age.

If you are under 18 years old as of October 18, 2015, your parent or guardian must complete the Parent Consent Form and you must complete the Under 18 Assent Form.

If you are 18 years old or over, you must complete the Over 18 Consent Form.

Once you have read, completed, and signed the required form(s), take a picture with your phone of the last page (the page that you signed) and attach that picture as instructed to do so in the survey you received.  You do not have to attach copies of all the pages of the consent form, just a copy of the last signed page.

 

For students under 18 years old:

pdfNetHealth Parent Consent Form
Download File
pdfNetHealth Under 18 Assent Form
Download File

For students 18 years old or older:

pdfNetHealth Over 18 Consent Form
Download File