Recruitment Source (URL tag):
Thank you for your interest in the WELL Center! Fully REMOTE participation is available for all studies that are currently recruiting. Thank you for your interest in the CGM study. The purpose of this study is to better understand the relationship between blood glucose and eating behaviors. You will be asked to record your meals and mood in real time on your phone through an app for 2 weeks. You will also record your activity and sleep on a smartwatch we will provide you with. Lastly, you will be asked to wear a small wearable glucose sensor that will be inserted to the skin on your abdomen. Participation for this study is fully remote and you will be compensated up to $500. Thank you for your interest in the WELL Center and the WELL Clinic! What is your name? * must provide value
Last* must provide value
What is your email address?* must provide value
Ex: abc123@drexel.edu
What is your phone number?* must provide value
Ex: (555) 555-5555
The WELL (Weight, Eating and Lifestyle Science) Center is an interdisciplinary clinical research center developing innovative interventions for issues related to obesity, poor diet, sedentariness, and disordered eating in adults, teens and children. Please let us know if you are interested in treatment/research for yourself, or for your child. Please choose only one answer. If you are interested in treatment/research for both you and your child, complete and submit one survey for your child and then come back to this survey and complete a second survey for yourself. (If your child is over 18, he or she should complete this form for him/herself.)* must provide value
I am 18 years old or older and I am interested in treatment/research for myself
I am under 18 years old and I am interested in treatment/research for myself
I am interested in treatment/research for my child
What is your current age?* must provide value
How would you describe your race (please select all that apply)?* must provide value
American Indian/Alaska Native
Asian
Hawaiian/Pacific Islander
Black or African American
White
More than one race (if selected, please also select the relevant earlier boxes)
Unknown or prefer not to say
What is your gender?* must provide value
Male
Female
Non-binary or other
What is your current height? (If you're unsure, please provide your best guess.)* must provide value
What is your current height? (If you're unsure, please provide your best guess.)* must provide value
What is your current weight? (If you're unsure, please provide your best guess.)
* must provide value
How did you first hear about the WELL Center? (Please enter any information that you remember about the source, such as the location, radio station, or professional who referred you).* must provide value
Friend, family member, acquaintance
Professional referral such as from physician, psychologist, or, nutritionist.
Postcard
Flyer
Newspaper
TV
Facebook/social media
Radio ad
Craigslist
Web search/Drexel Website
Referred from WELL clinic
Other
Please briefly describe how you first heard about the WELL Center.* must provide value
Do you live in the Philadelphia metropolitan area (e.g., within 25 miles of Philadelphia)?* must provide value
Yes
No
What time zone do you live in?* must provide value
Eastern Daylight Time
Central Daylight Time
Mountain Daylight Time
Mountain Standard Time
Pacific Daylight Time
Alaska Daylight Time
Hawaiian-Aleutian Standard Time
Are you available to complete study assessments and therapy sessions between 8am and 7pm EDT?* must provide value
Yes
No
Are you available to complete study assessments and therapy sessions between 8am and 7pm EDT (this would be between 7am and 6pm CDT )?* must provide value
Yes
No
Are you available to complete study assessments and therapy sessions between 8am and 7pm EDT (this would be between 6am and 5pm MDT )?* must provide value
Yes
No
Are you available to complete study assessments and therapy sessions between 8am and 7pm EDT (this would be between 5am and 4pm MST )?* must provide value
Yes
No
Are you available to complete study assessments and therapy sessions between 8am and 7pm EDT (this would be between 5am and 4pm PDT )?* must provide value
Yes
No
Are you available to complete study assessments and therapy sessions between 8am and 7pm EDT (this would be between 4am and 3pm AKDT )?* must provide value
Yes
No
Are you available to complete study assessments and therapy sessions between 8am and 7pm EDT (this would be between 2am and 1pm HAST )?* must provide value
Yes
No
Do you have at least one parent willing to participate in the research study with you?
For some studies that we have available, your parent would just need to consent (allow) you to participate in the study, and they may participate in some assessments that would include surveys and interviews. For other studies we have available, your parent would need to do those things as well as actively participate in therapy sessions with you. If one or both of these options would work for you, please select yes.
* must provide value
Yes
No
Do you have more than one parent who would be willing to participate in the research study with you?* must provide value
I have another parent and they would participate.
I have another parent, but I'm not sure they would participate.
I have another parent, but they definitely wouldn't participate.
I don't have another parent in my life.
What motivated you to reach out for treatment? Select all that apply.* must provide value
I am concerned about my weight or eating.
My parent is concerned about my weight or eating.
My doctor is concerned about their weight or eating.
Someone else in my life is concerned about my weight or eating.
Please select the concerns you have. Select all that apply.* must provide value
My weight is too high and/or I am rapidly gaining weight.
I would like to eat healthier and/or be more active.
My weight is too low and/or I am rapidly losing weight.
I lose control while eating, feel unable to stop eating once they start, feel regretful about how much I eat, or experience binge eating.
I am vomiting, using laxatives, diuretics, or diet pills, or using exercise in an unhealthy way in order to make up for an eating episode or control my shape or weight (for example, to lose weight, to make sure I don't gain weight, or to make my stomach flatter).
I am significantly restricting my food intake or fasting in order to make up for an eating episode or control my shape or weight (for example, to lose weight, to make sure I don't gain weight, or to make my stomach flatter).
I am a very picky eater.
I am concerned about my weight (the number on the scale).
I am concerned about my shape (the way I look - for example, my stomach is too big).
I don't want to gain weight or stop losing weight.
I am currently experiencing medical problems (diabetes, heart problems, etc.) as a result of my weight or eating behavior.
Other
Briefly describe the other concern(s) that you have. * must provide value
Have you been diagnosed with any of the following eating disorders? Select all that apply. * must provide value
Anorexia nervosa
Bulimia nervosa
Binge eating disorder
Avoidant and restrictive food intake disorder (ARFID)
Purging disorder
Another eating disorder, like other specified feeding or eating disorder (OSFED)
None of the above
Do you think you might have any of the following eating disorders, even if you have not been officially diagnosed?* must provide value
Anorexia nervosa
Bulimia nervosa
Binge eating disorder
Avoidant and restrictive food intake disorder (ARFID)
Purging disorder
Another eating disorder, like other specified feeding or eating disorder (OSFED)
None of the above
Have you previously received treatment for weight loss or for an eating disorder?* must provide value
Yes
No
Is your parent aware that you are seeking treatment for your eating/weight concerns?* must provide value
Yes
No
You may be eligible to receive treatment through a research study in the WELL Center.* must provide value
I am interested in obtaining treatment through a research study
I am not interested in obtaining treatment through a research study
Please click on the link below to schedule a phone screen for a research study. (Note: The link will open in a new tab. Please click submit on this survey and then schedule in the Calendly tab)Click Here Please confirm whether or not you have signed up for a phone screen by selecting an option below. Click Here * must provide value
Yes I signed up for a phone screen
No, I do not want to sign up for a phone screen at this time
You are likely eligible to receive evidence-based treatment at the WELL Clinic through our Child and Adolescent Program. Session fees range from $100-$175, depending on your therapist. * must provide value
I am not interested in treatment through the WELL Clinic at this time
I am interested in learning more about receiving fee-for-service treatment through the WELL Clinic
Please click on the link below to schedule a phone screen for the WELL Clinic. (Note: The link will open in a new tab. Please click submit on this survey and then schedule in the Bookings tab)Click Here Please confirm whether or not you have signed up for a phone screen by selecting an option below. Click Here * must provide value
Yes I signed up for a phone screen
No, I do not want to sign up for a phone screen at this time
How old is your child?* must provide value
10 or younger
11-18
What is your child's age?* must provide value
You and your child are likely eligible to receive evidence-based treatment at the WELL Clinic through our Child and Adolescent Program. Session fees range from $100-$175, depending on your therapist. * must provide value
I am not interested in treatment through the WELL Clinic at this time
I am interested in learning more about receiving fee-for-service treatment through the WELL Clinic
Please click on the link below to schedule a phone screen for the WELL Clinic. (Note: The link will open in a new tab. Please click submit on this survey and then schedule in the Bookings tab)Click Here Please confirm whether or not you have signed up for a phone screen by selecting an option below. Click Here * must provide value
Yes I signed up for a phone screen
No, I do not want to sign up for a phone screen at this time
What is your child's first name?* must provide value
What is your child's last name?* must provide value
What is your child's gender?* must provide value
Male
Female
Non-binary or other
How would you describe your child's race (please select all that apply)?* must provide value
American Indian/Alaska Native
Asian
Hawaiian/Pacific Islander
Black or African American
White
More than one race (if selected, please also select the relevant earlier boxes)
Unknown or prefer not to say
Do you live in the Philadelphia metropolitan area (e.g., within 25 miles of Philadelphia)?* must provide value
Yes
No
What time zone do you live in?* must provide value
Eastern Daylight Time
Central Daylight Time
Mountain Daylight Time
Mountain Standard Time
Pacific Daylight Time
Alaska Daylight Time
Hawaiian-Aleutian Standard Time
Is your child available to complete study assessments and therapy sessions between 8am and 7pm EDT?* must provide value
Yes
No
Is your child available to complete study assessments and therapy sessions between 8am and 7pm EDT (this would be between 7am and 6pm CDT )?* must provide value
Yes
No
Is your child available to complete study assessments and therapy sessions between 8am and 7pm EDT (this would be between 6am and 5pm MDT )?* must provide value
Yes
No
Is your child available to complete study assessments and therapy sessions between 8am and 7pm EDT (this would be between 5am and 4pm MST )?* must provide value
Yes
No
Is your child available to complete study assessments and therapy sessions between 8am and 7pm EDT (this would be between 5am and 4pm PDT )?* must provide value
Yes
No
Is your child available to complete study assessments and therapy sessions between 8am and 7pm EDT (this would be between 4am and 3pm AKDT )?* must provide value
Yes
No
Is your child available to complete study assessments and therapy sessions between 8am and 7pm EDT (this would be between 2am and 1pm HAST )?* must provide value
Yes
No
What is your child's current height? (If you're unsure, please provide your best guess.)* must provide value
What is your child's current height? (If you're unsure, please provide your best guess.)* must provide value
What is your child's current weight? (If you're unsure, please provide your best guess.)
* must provide value
What is your child's highest weight in the past 6 months? (If you're unsure, please provide your best guess.)
* must provide value
What is your child's lowest weight in the past 6 months? (If you're unsure, please provide your best guess.)
* must provide value
Are you willing to participate in treatment with your child (e.g., attend family therapy sessions)?* must provide value
Yes
No
Does your child have a second parental figure who would be willing and able to participate in treatment?* must provide value
My child has another parental figure who would be willing and able to participate in treatment
My child has another parental figure, but I am unsure if they would be willing or able to participate in treatment
My child has another parental figure, but they would not be willing or able to participate in treatment
My child does not have another parental figure in their life
What prompted you to reach out for treatment for your child? Select all that apply.* must provide value
My child asked me for help with weight or eating concerns they are having.
I am concerned about my child's weight or eating.
My child's doctor is concerned about their weight or eating.
Other
Briefly describe the other reason(s)/factor(s) that prompted you to seek treatment for your child. * must provide value
Please select the concerns you have about your child. Select all that apply.* must provide value
My child's weight is too high and/or my child is rapidly gaining weight.
I would like my child to eat healthier and/or be more active.
My child's weight is too low and/or my child is rapidly losing weight.
My child seems to lose control while eating, feels unable to stop eating once they start, feels regretful about how much they eat, or experiences binge eating.
My child is (or may be) vomiting, using laxatives, diuretics, or diet pills, or using exercise in an unhealthy way in order to make up for an eating episode or control their shape or weight.
My child is (or may be) significantly restricting their food intake or fasting in order to make up for an eating episode or control their shape or weight.
My child is a very picky eater.
My child is concerned about their shape or weight.
My child refuses to gain weight or stop losing weight.
My child is currently experiencing medical problems (diabetes, heart problems, etc.) as a result of their weight or eating behavior.
Other
Briefly describe the other concern(s) that you have about your child. * must provide value
Has your child been diagnosed with any of the following eating disorders? Select all that apply.* must provide value
Anorexia nervosa
Bulimia nervosa
Binge eating disorder
Avoidant and restrictive food intake disorder (ARFID)
Purging disorder
Another eating disorder, like other specified feeding or eating disorder (OSFED)
None of the above
Do you think your child might have any of the following eating disorders, even if they have not been officially diagnosed? Select all that apply.* must provide value
Anorexia nervosa
Bulimia nervosa
Binge eating disorder
Avoidant and restrictive food intake disorder (ARFID)
Purging disorder
Another eating disorder, like other specified feeding or eating disorder (OSFED)
None of the above
Has your child previously received treatment for weight loss or for an eating disorder?* must provide value
Yes
No
Is your child aware that you are seeking treatment for them for their eating/weight concerns?* must provide value
Yes
No
How did you first hear about the WELL Center? (Please enter any information that you remember about the source, such as the location, radio station, or professional who referred you).* must provide value
Friend, family member, acquaintance
Professional referral such as from physician, psychologist, or, nutritionist.
Postcard
Flyer
News on newspaper, TV
Facebook/social media
Radio ad
Web search
Craigslist
Drexel's Website
Referred from WELL clinic
Other
Please enter any information that you remember about the web search conducted.* must provide value
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