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:

gBsBu9EQgU4QaTzc9ucL3cKeM98pUnqJrThqjm2VBszrgwnS7HDZ3sXcAFLsNKdiVSTcsGfVoDngX3po8sRv

HS Research Studies Recruitment

Please fill out the form below. If you qualify for one of our studies, our team will reach out with additional information.

Subject ID

By filling out this survey, I consent to providing my information and to being contacted by the research team.

* must provide value

Yes

reset

Today's Date

* must provide value

M-D-Y

Demographics:

First Name

Middle Initial

Last Name

Date of Birth (MM-DD-YYYY):

Age:

Gender Identity:

Race:

Ethnicity:

Referring Dermatology Provider (if applicable)

Phone Number (no spaces or dashes):

Email:

Address:

Street
Apt
City
State
Zip Code

Select all HS therapies that you currently use.

Select all previous HS therapies you previously used.

Over the past week, how much has HS influenced your quality of life?

* must provide value

Click submit to finish the survey.

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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.

HS Research Studies Recruitment

Contact Information

The next set of questions are about HS (Hidradenitis suppurativa)

Click submit to finish the survey.

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