The code block below illustrates how one might use # and // as comments in your logic and calculations.

This value you provided is not a number. Please try again.

This value you provided is not an integer. Please try again.

The value entered is not a valid Vanderbilt Medical Record Number (i.e. 4- to 9-digit number, excluding leading zeros). Please try again.

The value you provided must be within the suggested range

The value you provided is outside the suggested range

This value is admissible, but you may wish to double check it.

The value entered must be a time value in the following format HH:MM within the range 00:00-23:59 (e.g., 04:32 or 23:19).

This field must be a 5 or 9 digit U.S. ZIP Code (like 94043). Please re-enter it now.

This field must be a 10 digit U.S. phone number (like 415 555 1212). Please re-enter it now.

This field must be a valid email address (like joe@user.com). Please re-enter it now.

The value you provided could not be validated because it does not follow the expected format. Please try again.

Required format:

M3umiFDSh6syhYxpxueIvXvXr3qi7W7TcmEibHRrR3QPLSJcRUMikCDX5ASV6MPaU6GA5kz7zf2d877ggUn93yLiwDYq9JnnCI3wfpqyECAvI

FXTAS SCREENER

Please complete the survey below.

Thank you!

Thank you for your interest in this research study being conducted at the University of Kansas Medical Center and the University of Kansas-Lawrence.

We are interested in understanding behavioral and brain based issues associated with the Fragile X gene, FMR1.

Study volunteers will complete:
-A blood draw
-Tests of brain function at the University of Kansas Medical Center in Kansas City
-Tests of motor skills and thinking abilities at KU in Lawrence.

Our tests of brain function are non-invasive and do not involve any radiation.

Testing will involve at least 1 visit to University of Medical Center and 1 visit to our lab in Lawrence (each visit is 2-4 hours, depending on availability). After approximately 24 months, you may be invited back to the lab to repeat the 2 visits of testing, as funding allows.

For questions about the rights of research participants, you may contact the KUMC Institutional Review Board (IRB) at (913) 588-1240 or humansubjects@kumc.edu

If you are interested in participating, please fill out this screener form. This screener will help the research team determine if you are eligible for our current studies. A member of the research team will contact you as soon as possible once this screener has been reviewed.

Please feel free to email (brainlab@ku.edu) or call (785) 864-4461 with any questions.

First name

Last name

Preferred Name

What is your birthdate (ex. MM/DD/YYYY)?

M-D-Y

What is your age?

What is your gender?

Male

Female

Other

FXTAS SCREENER

You have selected an option that triggers this survey to end right now.