Contraindication Screening Questionnaire for Participant Advisor Review
Note for reviewers: [This questionnaire is not live; response boxes cannot be clicked. The red-coloured text will appear when participants choose the associated response.]
Directions for completing this screening questionnaire
Please complete the screening questions to determine whether you are eligible to provide a blood sample and ensure that it is safe for you to do so. This questionnaire will take about two minutes to complete. You do not need to finish it all at once. Your information will be saved, and you may return to it anytime during the next 7 days.
Please note that your responses to these questions will be stored to ensure that we do not re-contact you if you are ineligible to provide a sample or if you do not wish to do so.
If you are not sure how to answer a question, please contact us at 1-866-606-0686 or info@ontariohealthstudy.ca
1. Are you willing to provide a blood sample to the Ontario Health Study?
□ Yes → go to 2
□ Not now. Send me a reminder invitation in 6 weeks. → go to 2
□ No. Do not send me further invitations to provide a blood sample.
Message displayed when Participant indicates ‘No’:
Thank you for taking the time to complete the screening questionnaire. The Study is always growing and there will be more ways you can participate in the Ontario Health Study.
2. Have you ever been diagnosed with cancer?
□ Yes → Participant is contraindicated message
□ No → go to 3
□ Don’t know → Participant is contraindicated message
Contraindication message:
Thank you for taking the time to complete the online screening questionnaire for the Ontario Health Study. Based on the responses that you have provided, it is recommended that you not provide a blood sample.
The Study is always growing and there will be more ways you can participate in the Ontario Health Study. If you have any questions or concerns, please contact the Study team at info@OntarioHealthStudy.ca or 1-866-606-0686.
3. Are you positive for Hepatitis B, Hepatitis C, or HIV?
□ Yes → Participant is contraindicated message
□ No → go to 4
□ Don’t know → Participant is contraindicated message
4. Do you have a blood clotting condition such as hemophilia?
□ Yes → Participant is contraindicated message
□ No → go to 5
□ Don’t know → Participant is contraindicated message
5. Have you had a mastectomy, or have you experienced swelling in one or both arms?
□ Yes → Participant is contraindicated message
□ No → go to 6
□ Don’t know → Participant is contraindicated message
6. Have you ever had lymph nodes removed from your arm or chest?
□ Yes → Participant is contraindicated message
□ No → go to 7
□ Don’t know → Participant is contraindicated message
7. Have you donated blood in the past 48 hours?
□ Yes → For your safety, we ask that you please wait at least 48 hours (2 days) after donating blood before providing a blood sample to the Ontario Health Study.
□ No → go to 8
□ Don’t know → For your safety, we ask that you please wait at least 48 hours (2 days) after donating blood before providing a blood sample to the Ontario Health Study.
8. Have you received a blood transfusion in the past 6 months ?
□ Yes → To allow your body sufficient time to adapt to a transfusion, it is recommended that you not provide a blood sample at this time.
□ No → go to the message that screening is complete/proceed to Consent
□ Don’t know → It can take up to 6 months for your body to adapt to receiving blood intravenously (a blood transfusion). Out of caution for your health, it is recommended that you not provide a blood sample at this time.
Message that screening Qx is complete/proceed to Consent:
Thank you for completing the screening questionnaire. Click “Continue” to read the consent form.