Trauma Research Study Enrollment Form
Complete this form to enroll in the Trauma Research Study and share the basic information needed to review your participation interest.
Participant Information
Full Name
*
First Name
Middle Name
Last Name
Preferred Name
Age
*
Preferred Contact Method
*
Email
Phone
Text Message
Other
Study Screening and Availability
Study exposure category
*
Direct trauma exposure
Witnessed trauma
Indirect exposure (e.g., first responder, helper)
Multiple types of exposure
Prefer not to say
Brief eligibility or inclusion notes
Preferred availability for participation
*
Additional Enrollment Notes
Additional comments or questions
I confirm that the information I provided is accurate and complete
*
Yes
Submit Enrollment
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