VADAC Health Study: Expression of Interest
This form collects information used to determine eligibility in the health study.
* Required
Email address
*
Your email
First and Last Name
*
Your answer
Age
*
65-70
71-75
76-80
81-85
86-90
91-95
95+
Gender Identity
*
Female
Male
Non-Binary
Prefer not to say
Please provide your mailing address. Please note that at this time we are recruiting participants from Gabriola only.
*
Your answer
Do you consent to receive, from time to time, further information by email on this study or other health related subjects from PHC? Your answer to this question does not affect your eligibility in this study.
*
Yes
No
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This form was created inside of People for a Healthy Community on Gabriola Society.
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