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Hello:
You are invited to participate in our survey about attitudes towards death. In this survey, approximately 100 people will be asked to complete a survey that asks questions about death. It will take approximately 5 minutes to complete the questionnaire.

Your participation in this study is completely voluntary. There are no foreseeable risks associated with this project. However, if you feel uncomfortable answering any questions, you can withdraw from the survey at any point. It is very important for us to learn your opinions.

Your survey responses will be strictly confidential and data from this research will be reported only in the aggregate. Your information will be coded and will remain confidential. I
Thank you very much for your time and support. Please start with the survey now by clicking on the Continue button below.

 
 
 
 
Has someone close to you ever passed away?
 
Yes
 
No
 
 
 
Was it a relative or friend? Please refer to the person you felt the closest to.
 
Relative
 
Friend
 
 
 
How often do you conduct surveys?
 
Mother
 
Father
 
Grandfather
 
Grandmother
 
Son
 
Daughter
 
Other
 
 
 
How old was this person?
   
 
 
 
How close did you feel to this person, on a scale of 1-7? With 1 being very close and 7 being not very close.
 
1
 
2
 
3
 
4
 
5
 
6
 
7
 
 
 
How long ago did they pass away?
   
 
 
 
How long had you known him or her?
   
 
 
 
Did he or she pass away suddenly?
 
Yes
 
No
 
 
 
What best describes their cause of death?
 
Old age
 
Cancer
 
Heart attack
 
Birth defect
 
Other
 
 
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