Vascular Dysfunction in the Chronic Fatigue Syndrome

 

Screening

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

Courtney Terilli RN or Julian M. Stewart MD, PhD
Suite 1400
19 Bradhurst Building
New York Medical College
Hawthorne, NY 10532

The downloaded screening questionnaire (msword, pdf ). If mailed this   requires postage to mail or you can attach it as an Email attachment to courtney_terilli@nymc.edu  or 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, pdf)

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.