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Screening Form
Please complete the screening form below.
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What city do you live in?
What state do you live in?
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Which Province or Territory do you live in?
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Which category best describes you?
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Do you have a current diagnosis of IBD (Crohn's disease or Ulcerative Colitis - this does not include IBS)?
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Can your diagnosis be verified through medical records?
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Do you have access to mychart or epic?
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Other
Would you be willing to donate a saliva sample?
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You agree that BuildClinical may provide your personal information to the research site to help determine if you are eligible for this study. Please refer to BuildClinical's Terms of Service and Privacy Policy for more information.
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BCFS00652
