Please complete the survey below to be included in the CRoFT Future Contact Data Repository. Please note that you must be at least 18 years old to qualify for this Data Repository.

By filling out this form, you are giving us permission to contact you if there is a study for which you might qualify to see if you are interested in participating. Your contact information will be stored in a secure University of Rochester site.

If at any time you want to be removed from this Future Contact database after registering, please email us at croft_study@urmc.rochester.edu. You can also use that email to notify us of any changes to your information.

You will have a chance to download this form for your records at the end of the survey. This form takes approximately 5-15 minutes to complete.

Thank you!

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