Screening Form
Please complete the screening form below
First Name
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Last Name
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Phone Number
Email Address
Gender
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Male
Female
Date of Birth
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How old are you (in years)?
Sex assigned at birth?
Male
Female
Prefer not to say
Are you currently using hormonal contraceptives or other medications that affect your hormones?
Yes
No
How many drinks do you typically consume each week?
1-7
7+
On a normal week, how many days per week do you have at least one drink?
Under 4 days per week
Over 4 days per week
Are you able to attend in-person visits at Rutgers University in New Brunswick, New Jersey?
Yes
No
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