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Screening Form
Please complete the screening form below
First Name
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Last Name
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Phone Number
Email Address
Gender
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Male
Female
Date of Birth
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What city do you live in?
What state do you live in?
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What category best describes you?
American Indian or Alaska Native
Asian
Black or African American
Hispanic, Latino, or Spanish origin
Middle Eastern or North African
Native Hawaiian or Other Pacific Islander
White
Are you 18-30 years old?
Yes
No
Are you currently taking any psychiatric medications?
Yes
No
Do you have any non-removable metal on or in your body, or any other MRI contradictions?
Yes
No
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