About this Research Study

We are doing a research study to learn if and how children's shed primary or “baby” teeth record information about their early life experiences. We are looking to recruit mothers and their children who were born from April 1, 2012, to November 4, 2013, to participate in this study. Filling out this questionnaire will take about 5 minutes of your time and will help us determine your eligibility to participate in this study.

If you fill it out, you are agreeing to allow us to use it for research, and to allow us to contact you to follow up in two ways:

  1. If you and your child are found eligible to participate, we will contact you to let you know more about the study, collect more detailed information about you and your child, and obtain your consent if you would like to participate.

  2. If you and your child are not eligible, we will contact you in the future about other study opportunities that you may be eligible for.

This survey will take about 5 minutes to complete. It is not expected that any of these questions will make you feel uncomfortable, however, you may stop the survey at any time. The risk of allowing us to record your name with your answers is a loss of confidentiality. We will take reasonable steps to protect the confidentiality of your information.

HIPAA Notice: We are required by the Health Insurance Portability and Accountability Act (HIPAA) to protect the privacy of health information obtained for research. This is an abbreviated notice and does not describe all details of this requirement (see Partners Privacy Notice*). During this study, identifiable information about you or your health will be collected and shared with the researchers conducting the research. In general, under federal law, identifiable health information is private. However, there are exceptions to this rule. In some cases, others may see your identifiable health information for purposes of research oversight, quality control, public health and safety, or law enforcement. We share your health information only when we must, and we ask anyone who receives it from us to protect your privacy.


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