Aphasia Research Center Contact Form

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Please submit this form if you would like to be contacted about participation in the studies at the Aphasia Research Center

Name *

Age

Gender

Male

Female

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Phone number

Email address

Preferred method of contact

Phone

Mail

Other:

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Relevant health history

Please let us know a little more about you.

Participant with recent language difficulty after stroke (aphasia)

Participant with healthy neurological history currently attending UMD

Participant with healthy neurological history between 18 and 25 years old, not attending UMD

Participant with healthy neurological history over 45 years old

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Language history

What languages do you speak? Please select all that apply.

English

Spanish (Hispanic)

Hindi, Gujarati, Urdu, Tamil, or another Indian language

Other:

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