Eligibility Form

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Eligibility Form

Thank you so much for your interest in Muse Bio's Alpha study! This form will ask questions regarding study eligibility. Once complete, you will proceed to enroll in the study.

This information will be stored securely and only be used internally to determine study eligibility.

For any questions please contact the principle investigator: Aya Fattah— aya@mycells.bio

What is your first name? *

What is your last name? *

What email address should we use to contact you? *

Please enter your phone number *

When was the first day of your last period?

(If you don't know please estimate to the best of your ability)

YYYY

When do you expect your next period to start?

(If you don't know please estimate to the best of your ability)

YYYY

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