Screening Form

Please complete the screening form below if you are interested in enrolling your child in

our study. Our team will contact you if you are eligible to participate. Thank you!

The information provided will be stored in BuildClinical's platform. BuildClinical's Secure Socket Layer (SSL) software, which encrypts all inputted information, keeps your information private and HIPAA compliant. Our backend servers are stored in the USA at some of the most secure data centers in the world. Information provided in the screening form will be deleted once the study is complete, and is not used for purposes other than the study. If you have any questions about the study, please contact AndrĂ© Eliatamby at: or 917-342-5165.