Please answer all of the following questions. A study team member will contact you after you have submitted this form.

These questions are for tracking purposes and to determine if you are eligible for this study. Some of these questions will be personal in nature, such as about some medical or mental health conditions and any drugs you are taking for medical purposes. If you feel these questions are too personal, feel free to stop. All information that we collect is confidential.

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You have selected an option that triggers this survey to end right now. To save your responses and end the survey, click the button below to do so. If you have selected the wrong option by accident and do not wish to leave the survey, you may click the other button below to continue, which will also remove the value of the option you just selected to allow you to enter it again and continue the survey.
The response has now been removed for the last question for which you selected a value. You may now enter a new response for that question and continue the survey.