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Thank you for your interest in our study! Please complete the following questionnaire to help us determine your eligibility for the program.
Have you participated in any clinical trial in the past 30 days?
Do you use any narcotic drugs?
List what type and how often you use them.
Do you have a health condition that requires care of a physician?
How would you describe your overall health (outstanding, very good, good, fair, poor)?
Are you under the care of a physician for a medical or psychiatric problem?
Do you smoke cigarettes on average one or more times per month?
Do you have high blood pressure that was diagnosed by a doctor?
Do you have diabetes that was diagnosed by a doctor?
In the past month have you had any problems sleeping (e.g., can’t get to sleep or stay asleep)?
In the past month have you had any mental health problems (e.g., severe or persistent anxiety or depression or eating disorder)?
Excluding birth control, in the past month have you taken any prescription medications?