Please complete this brief questionnaire to see if you are eligible for additional screening at one of the participating research study centers. If you are eligible for participation you will meet with the investigator conducting the study, be advised of important information regarding the trial and, if you decide to participate, be asked to sign an informed consent form. If you choose to participate in the study, once you are enrolled, you will receive study-related medical care including health-related assessments and investigational drug. Qualified participants may withdraw from the study at any time.
In order to determine if you may be eligible for this clinical study, it is necessary that you answer a number of questions about your health and present condition. This questionnaire should take a few minutes of your time. You do not have to answer any questions that you do not want to, however we may not be able to determine if you may be eligible unless all questions are answered. Your answers to these questions will only be given to the research center if you may be eligible and if you tell me it is OK to do so. Your answers to these questions will be stored in a database for the duration of the active study recruitment period and an additional one year after recruitment has ended.