Qualtrics Survey | Qualtrics Experience Management

We are looking for babies, toddlers, and children to take part in our short studies of child cognitive development. To volunteer, please fill in the form below. Someone from the LLAMB Lab - Yale University will contact you afterward. Alternatively, contact us by email via llamblab@haskins.yale.edu.

Your Name

Email

Phone Number (xxx-xxx-xxxx)

Zip Code

Which one of the following statements describes you? (select all that apply)

Expecting a baby
Parent of an infant or a child

Expected Due Date (mm/dd/yyyy)

May we contact you within one month after the expected date of delivery to confirm your child's name, date of birth, sex, gestational age?

Yes
No

***Already Born Child***

Add Another Child?

Yes
No

Child Name

Child Date of Birth (mm/dd/yyyy)

Child Sex

Male
Female

Child Gestational Age at Birth (weeks)

Add Another Child?

Yes
No

Child 2 Name

Child 2 Date of Birth (mm/dd/yyyy)

Child 2 Sex

Male
Female

Child 2 Gestational Age at Birth (weeks)

Add Another Child?

Yes
No

Child 3 Name

Child 3 Date of Birth (mm/dd/yyyy)

Child 3 Sex

Male
Female

Child 3 Gestational Age at Birth (weeks)

Additional Information? (optional)