012_Vedanta_VE303-003_VED0001187_TLP

Please click "Next" below.

This survey is not available for individuals aged 120 or older. If you have submitted an incorrect date of birth, please correct this date on the previous page to continue answering this survey.

Sorry, but according to your state laws, you will need a parent or guardian’s permission to answer the pre-screener questions.

Please provide the following information for the Parent/Legal Guardian:

Your First Name*

Your Last Name*

Your Email Address*

Your Phone Number*

Please enter a valid phone number.

Your preferred method of communication:*

EmailText MessagePhone Call

Please provide the following information for the Patient:

Patient's First Name*

Patient's Last Name*

Do you give permission for us to contact the patient directly to discuss participation in the study?*

YesNo

Please provide the patient's preferred contact method:*

EmailText MessagePhone Call

Patient's Email Address*

Patient's Phone Number*

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Patient's Street Address

Street Address Line 2 (Apartment, Suite, etc.)

City*

State*

Zip Code*

Race/Ethnicity*

Has the patient ever had a doctor’s diagnosis of C. diff infection (Clostridioides difficile infection, CDI)?*

YesNo

__TMP__DQ_Not diagnosed with CDI

Vedanta C. Diff TLP Status

TLP_Multi_DQ

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crm_id

Thanks for your interest in our study. We’ll now ask you a couple of key questions related to this study.