007_Acer_Acer-002-301_ACR0001293_TLP_V03

  • The DiSCOVER Trial for VEDS

    HAVE QUESTIONS: (984) 253-4376 or vedstudy@science37.com

  • Thanks for your interest in our study. We will now ask a few key questions related to this study.

    If you are a parent or legal guardian of the potential participant for this clinical research study, answer the below on the behalf of the participant.
  • Are you signing up to participate in this clinical research study for yourself or for your child?*
  • Participant's Date of Birth*
     / /
  • __TMP__Today's Date
     / /

  • Based on the date of birth you entered, your age appears to be incorrect. Please double check your date of birth to proceed.

  • __TMP__reside_in_MS
  • __TMP__Age/State Pass_Fail
  • __TMP__IneligibleMinor

  • HAVE QUESTIONS: (984) 253-4376 or vedstudy@science37.com

  • 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:

  • Format: (000) 000-0000.
  • Your preferred method of communication:*

  • By providing your email and phone number, you are authorizing Science 37 to contact you about this and other studies, and you agree to the Privacy Policy. We may send you a text message regarding these studies. Message and data rates may apply.

  • Please provide the following information for the Participant:

  • Do you give permission for us to contact the participant directly to discuss participation in the study?*
  • Please provide the participant's preferred contact method:*
  • Format: (000) 000-0000.

  • By providing your email and phone number, you are authorizing Science 37 to contact you about this and other studies, and you agree to the Privacy Policy. We may send you a text message regarding these studies. Message and data rates may apply.

  • Do you (or your child) have a diagnosis of Vascular Ehlers-Danlos Syndrome (VEDS)?*
  • Please indicate how you heard about the study:*
  • Should be Empty: