Start Enrolling as a Study Participant
Thank you for your interest. This form is the first step of the enrollment process. After completing this step we will email you a confirmation with specifics on how to complete the remaining enrollment steps.

If you are completing this form on a mobile device and having difficulty viewing or scrolling, we recommend opening it in a new tab by clicking on this direct link:


This form has 12 questions spanning 2 sections. We estimate a completion time of 3-7 minutes for most viewers. You only need to submit once and you will be shown a confirmation screen indicating you've successfully done so.

If you do not receive a confirmation email or you have questions that are not answered by the confirmation email, please contact us at with questions.

Thank you. Click Next to proceed
Never submit passwords through Google Forms.
This form was created inside of Pro-Activity Associates, LLC. Report Abuse