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Department of Behavioral Science Survey Form


To help us determine which studies you may be eligible for, please answer the questions on the following pages as completely as possible.

On the last page you will be given the option to either leave your name and phone number so we can contact you or to enter a code and call us back in 1-2 days at 859-277-3799 using the code to find out if you are eligible.

Warning: If you choose to create a code and you forget it, we will not be able to retrieve it for you.

If you are interested in Tobacco and/or Marijuana studies please read.
If you are interested in participating in tobacco and/or marijuana studies we need to evaluate your use. At the end of this survey you will be given the opportunity to complete a “Cigarette Use Questionnaire and/or a Marijuana Use Questionnaire”. Please provide the requested information to the best of your ability. Without this information we may not be able to determine your eligibility for some studies.

To begin the survey process click the "Next" button below.