Thank you for your interest in our research! We ask that you answer the questions below about your health and medical history as accurately as possible to help us determine if you might qualify for the study. We only ask for your phone number so that we can directly follow up with you about the study.

Please note the survey will record your answers to these questions for us to review. The risk of allowing us to collect and record your name with your answers is a loss of confidentiality. We will take reasonable steps to protect the confidentiality of your answers and personal information.

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