Clinical Study Eligibility Questionnaire

Thank you for your interest in learning more about this clinical study.

Please take a few minutes to complete this eligibility questionnaire. The questions will ask about your symptoms, medical history, and other basic health information that may be relevant to the study.

1. Your responses will be reviewed to help determine whether you may meet the initial eligibility criteria for this clinical study.
2. Based on the information you provide, you may be guided to the next steps if your responses indicate that you could be a potential match for the study.

Please answer each question as accurately and completely as possible. Completing this questionnaire does not guarantee eligibility or participation in the clinical study. Final eligibility will be determined by the study team based on the complete study requirements and any additional assessments that may be needed.

If you appear to be a potential match, you will be provided with information about the next steps and how you can learn more about participating in the study.

Estimated time: A few minutes to complete.

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