Online Eligibility Screening Form

Thank you for your interest in this study.

Before you move on to the Consent form, it would be necessary to confirm that you are eligible to participate in the study. Below, you will be asked some basic questions about your eligibility to enroll in the study. It should take about 2 minutes to go through these questions.

Some of the questions may make you uncomfortable; you do not have to answer any question that you would not like to answer, but without answers to these questions, you will not be eligible to participate in the study. Your responses will not be recorded with any identifiable information, such as your name, until after you are enrolled in the study.

At that time, any of your identifiable information will be kept secure. If you do not enroll in this study, we will keep the information we collect during this pre-screening but there will be no way for anyone to link that information to you.

If you have any questions or concerns, please contact the Ethics Board that oversees this research.

COMIRB, (303) 724-1055.

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