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:

PzjxTSIqGAHB3DLRRZo63Zg8vwqLpueyLSNFj9n9NVHHgJz5aaFAI4Xnc7sFQaqJiuvtW9CQfjaiINJwR6rrPUGXxKBdqxTtGAkm

Project Raptor Screening Form

Please answer all of the following questions. A study team member will contact you after you have submitted this form.

These questions are for tracking purposes and to determine if you are eligible for this study. Some of these questions will be personal in nature, such as about some medical or mental health conditions and any drugs you are taking for medical purposes. If you feel these questions are too personal, feel free to stop. All information that we collect is confidential.

Page 1 of 2

What is your current age?

* must provide value

Are you currently taking any medications?

* must provide value

Yes

reset

2.1

Please list your medications and how often you take them.

* must provide value

Expand

Were you exposed to combat in the military, regardless of whether you were in an official combat role?

* must provide value

Yes

reset

3.1

When were you most recently exposed to combat?

* must provide value

3.2

Can you briefly describe your combat exposure in one sentence?

3.3

Have you ever served in the military (in any branch)?

Yes

reset

Have you ever had seizures, hallucinations, or delusions because you stopped drinking alcohol?

* must provide value

Yes

reset

Are you able to wear a mask for a prolonged amount of time (e.g., COVID-19 Mask)?

* must provide value

Yes

reset

Have you ever worked with metal (i.e., grinding, fabrications, etc.) or ever had an injury to the eye involving metallic objects (e.g., metallic slivers, foreign body, etc.)?

* must provide value

Yes, I have worked with metal

Yes, I have had an injury to the eye involving metallic objects

6.1

Do you have an orbital x-ray or would you be willing to have one done at our expense?

Yes, I have an orbital x-ray

Yes, I would be willing to get an orbital x-ray at the study's expense.

No, I don't have an x-ray and I am unwilling to get one

Have you ever had an invasive procedure or surgery to your head or body?

* must provide value

Yes

reset

7.1

Briefly describe your invasive procedure or surgery.

* must provide value

Have you ever sustained a head injury or ever lost consciousness?

Yes

reset

8.1

Can you tell us what happened?

* must provide value

8.2

How many minutes were you unconscious?

* must provide value

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

To save your responses and end the survey, click the 'End Survey' button below. If you have selected the wrong option by accident and/or wish to return to the survey, click the 'Return and Edit Response' button.