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Joyful Together®
Joyful Together® Follow-up
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Fathers Feelings Follow-up Interview Study
CareSource Project Forms
The Maternal Vitality Study
Maternal Vitality Study- For Women/Mothers
MVS Clinician Form
Staff Forms
PFS-2-Staff
Staff Joyful Together® Fidelity Tool
Supervisor Fidelity Process Guidance Tool
Clinical Note
Intervention Note
Closing Note
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OhioGuidestone Research Portal
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Toggle Navigation
Home
About
Media Release Forms
Joyful Together®
Joyful Together® Follow-up
Father’s Feelings
Fathers Feelings Follow-up Interview Study
CareSource Project Forms
The Maternal Vitality Study
Maternal Vitality Study- For Women/Mothers
MVS Clinician Form
Staff Forms
PFS-2-Staff
Staff Joyful Together® Fidelity Tool
Supervisor Fidelity Process Guidance Tool
Clinical Note
Intervention Note
Closing Note
Joyful Together® Interest Sign-Up
Please enable JavaScript in your browser to complete this form.
Electronic Agreement
*
By checking this box, I agree to use electronic records and electronic signatures.
Parent/Guardian Name
*
First
Last
Phone Number
*
Email
*
Mailing Address
Address Line 1
Address Line 2
City
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
How many children between 0 months - 10 years old live in your household?
How many children 0-18 months old?
*
How do I answer this if I am pregnant? Please include any children who are not born yet in your answer for "How many children 0-18 months old?". For example, if you have a 1 year old and are 5 months pregnant, please put 2 for your answer to this question.
How many children 18-36 months old?
*
How many children 3-5 years old?
*
How many children 6-10 years old?
*
How did you hear about Joyful Together®?
How was this form completed?
*
In-Person
By Phone
Online
Mail-In
Acceptance
*
I understand that by checking this box and submitting this form, I am giving permission to Research Team members to call, email and/or text me to follow up about my interest in the Joyful Together® study.
Message
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