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Questionnaire
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 the Principal Investigator:
Julian M. Stewart
MD, PhD
New York Medical College
19 Bradhurst Ave. Suite 1600
Hawthorne, NY 10532
The downloaded
screening questionnaire (pdf)
requires postage to mail or you
can attach it as an Email attachment to stewart@nymc.edu
or
you can also fax us a copy at
914-593-8890.
If you are unable
to view or
print this form and still desire to find out about your eligibility,
please contact the investigators at the
above address or at stewart@nymc.edu and you will be mailed a copy.
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