All participant data will be treated with the utmost confidentiality. Personal information about potential and enrolled participants will be collected, shared, and maintained to protect confidentiality before, during, and after the trial.
First Name
*
Last Name
Email Address
*
Phone No.
*
Gender
Select Gender
Male
Female
Non-binary
Other
Race
choose one option
American Indian
Black
African American
Native Hawaiian
Alaska Native
White
Date of Birth
*
Day
*
Month
*
Year
*
Employment Status
*
Select one
Full-time employed
Part-time employed
Self-employed
Contract Worker
Homemaker
Retired
Student
Unemployed
Health Issues
*
Hyperlipidemia
Hypertension
Mental Health Issues
Digestive Disorders
Skin Conditions
Cardiovascular Disease
Diabetes
None
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