Support Group Qualifying Form

Support Group Enrollment Form

The purpose of this enrollment form is to find participants for a RESOLVE study that will focus on the emotional well-being of the patients that attend support groups and how their participation impacts their attitudes toward staying in or starting medical treatment. Participants will be selected based on whether they meet the study requirements.

First Name

Last Name

ZIP Postal Code

Email Address

Gender

What is your relationship to infertility?

Communications

Yes, I want to receive email communications from RESOLVE.

Please select what applies to your current situation.

Are you currently thinking about pursuing treatment through Assisted Reproductive Technology?

Yes

No

Have you attended more than six support groups (including non-RESOLVE support groups)?

Yes

No

RESOLVE is a non-profit, 501(c)(3) organization certified under the National Health Council Standards of Excellence and America's Best Charities as well as earned the Guidestar Gold Seal of Transparency.

RESOLVE: The National Infertility Association
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