If you are interested
in becoming a participant in this study, you must be screened to determine
your eligibility. This screening is done via the linked form, which
you may print, fill out and mail to
RN or Julian M. Stewart
19 Bradhurst Building
New York Medical College
Hawthorne, NY 10532
screening questionnaire (msword, pdf ).
If mailed this requires postage to mail or you
can attach it as an Email attachment to
you can also fax us a copy at
914-593-8890. We will also need your pertinent medical records, but
contact concerning eligibility should be made first.
We would also like
you to fill out the autonomic questionnaire (msword,
If you are unable
to view or print these forms and still desire to find out about your eligibility,
please contact the study team and you will be mailed a copy.