Hurricane Harvey Registry

Consent Form for Participation in the Hurricane Harvey Registry

The Hurricane Harvey Registry will collect health and housing information from residents in the Hurricane Harvey-impacted area. This information will support planning for future natural disasters by identifying health trends and risk associated with Harvey.

If you choose to participate, you will be asked to complete a survey with questions about you and your experience before, during, and after Hurricane Harvey. Some questions are required. The survey is open to any adult 18 or older who lived in the Harvey-impacted area during August 2017 – September 2017. The survey will take 10 minutes to complete. Participation is voluntary and you may stop at any time.

For some participants, questions about Hurricane Harvey may be distressing. If you do feel distressed, free 24/7 counseling and support is available from the Red Cross Distress hotline at 1-800-985-5990, or by texting “TalkWithUs” to 66746.

We are committed to protecting your privacy and maintaining confidentiality. If you have any additional questions about the study you can contact Dr. Marie Lynn Miranda, the project’s lead investigator, at If you have questions about your rights as a research participant, you should contact Stephanie Thomas, Compliance Administrator, at Rice University. You can contact her at 713-348-3586.

The Hurricane Harvey Registry is a joint venture of Chambers County, Environmental Defense Fund, Fort Bend County, Harris County Public Health Department, Houston Health Department, Montgomery County, Victoria Emergency Management, and Rice University. It is funded by the Environmental Defense Fund, the Cullen Trust for Healthcare, and the National Institutes of Health. Please send any comments or questions to Privacy Policy v1.12