The purpose of this prescreening form is to determine if a person may meet basic eligibility requirements for the VIVA-MIND trial. The VIVA-MIND clinical research trial is coordinated by the Alzheimer’s Disease Cooperative Study (“ADCS) at the University of California, San Diego and is taking place at academic medical centers and Alzheimer’s disease specialty clinics across the U.S. The ADCS and the VIVA-MIND clinical trial site receiving the information contained in this prescreening form will not share or retain the data for use other than determining VIVA-MIND trial eligibility. If you are not qualified for the VIVA-MIND trial, the ADCS and VIVA-MIND clinical trial sites will not contact you regarding other clinical research opportunities without your express permission.

Please note, at the end of this prescreening form, you will be asked to agree to share the data in this prescreening form with the BuildClinical software platform. Please review the BuildClinical Terms of Service and Privacy Policy before submitting this form to understand how your data may be used by BuildClinical.