Please fill out the “General Medical Questionnaire” below. It will take less than 10 minutes.

After completion, you will be able to register for a time slot to draw your blood on November 16, 2019. If you do not currently have time to complete the below questionnaire, please make a note of the following web address so you can return at a more convenient time: http://thebenchwithbedsideinitiative.com/general-medical-questions.

Please note: In order to participate in this study, you will need to complete this form.

We look forward to working with you and being transparent with our findings.