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What is a Medical Research Study?
To see if you may qualify for this clinical research study,
please complete this Pre-Qualifying Questionnaire.
These questions are to be answered by the person who would be participating in the clinical research study if they
qualify. If you are visiting this website for someone else, please provide this website link to them so that
they may complete the questionnaire.
As used in these questions, “you” or “your” refers to the person who would be participating in the clincial research
study if they qualify.
Privacy and Confidentiality Policy: If you pre-qualify for this research study, you will be given a choice
to submit your contact information along with your answers to the preliminary questionnaire to a study
center conducting this clinical research study for further evaluation. If you make the choice to submit
your contact information, your contact information will only be shared with those involved with the clinical
research study and will not be shared or provided to any other person or business not related to this
particular clinical research study. Except as noted above, your name and contact information will not
be taken from you and your answers will remain confidential. We will not use your information for
any purpose other than to screen you for potential participation in this clinical research study.
Your answers will be stored electronically and for auditing purposes any identifying information
that you provide to us will remain stored for up to seven years. If you provide your or a
friend’s/family member’s email address, the email address will not be provided to anyone other
than the person to whom the email was sent as specified in this website. The person in charge of
privacy for this website is the Privacy Officer, who may be contacted at 6207 Bee Cave Road, Suite 288, Austin, Texas 78746
or firstname.lastname@example.org to make any updates to your information or to have your information removed.