Name of participant
* must provide value
Date of Birth
* must provide value
Today Y-M-D
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Gender
* must provide value
Male
Female
Other
Please specify
* must provide value
Race (Optional)
* must provide value
White
Black
Hispanic/Latino
Asian or Pacific Islander
American Indian or Alaskan Native
Prefer not to answer
Other
Please select all that apply
Please specify
* must provide value
Handedness
* must provide value
Right
Left
Approximate weight
* must provide value
Please include units (i.e. lb or kg)
Approximate height
* must provide value
Please include units (i.e. ft or cm)
Parent/Guardian Name
* must provide value
Primary Phone Number
* must provide value
Email
* must provide value
Do you have any metal in or on your body (i.e. orthodontic devices like braces or permanent retainer, surgical/metallic/magnetic/electronic implants, permanent piercings, protheses, tattoos, medical patches)?
* must provide value
Yes
No
Do you feel or tend to feel claustrophobic?
* must provide value
Yes
No
Would you like to add information for another volunteer?
* must provide value
Yes
No
Name of participant
* must provide value
Date of Birth
* must provide value
Today M-D-Y
Gender
* must provide value
Male
Female
Other
Please specify
* must provide value
Race (Optional)
* must provide value
White
Black
Hispanic/Latino
Asian or Pacific Islander
American Indian or Alaskan Native
Prefer not to answer
Other
Please select all that apply
Please specify
* must provide value
Handedness
* must provide value
Right
Left
Approximate weight
* must provide value
Please include units (i.e. lb or kg)
Approximate height
* must provide value
Please include units (i.e. ft or cm)
Do you have any metal in or on your body (i.e. orthodontic devices like braces or permanent retainer, surgical/metallic/magnetic/electronic implants, permanent piercings, protheses, tattoos, medical patches)?
* must provide value
Yes
No
Do you feel or tend to feel claustrophobic?
* must provide value
Yes
No
Would you like to add information for another volunteer?
* must provide value
Yes
No
Name of participant
* must provide value
Date of Birth
* must provide value
Today M-D-Y
Gender
* must provide value
Male
Female
Other
Please specify
* must provide value
Race (Optional)
* must provide value
White
Black
Hispanic/Latino
Asian or Pacific Islander
American Indian or Alaskan Native
Prefer not to answer
Other
Please select all that apply
Please specify
* must provide value
Handedness
* must provide value
Right
Left
Approximate weight
* must provide value
Please include units (i.e. lb or kg)
Approximate height
* must provide value
Please include units (i.e. ft or cm)
Do you have any metal in or on your body (i.e. orthodontic devices like braces or permanent retainer, surgical/metallic/magnetic/electronic implants, permanent piercings, protheses, tattoos, medical patches)?
* must provide value
Yes
No
Do you feel or tend to feel claustrophobic?
* must provide value
Yes
No
Would you like to add information for another volunteer?
* must provide value
Yes
No
Name of participant
* must provide value
Date of Birth
* must provide value
Today M-D-Y
Gender
* must provide value
Male
Female
Other
Please specify
* must provide value
Race (Optional)
* must provide value
White
Black
Hispanic/Latino
Asian or Pacific Islander
American Indian or Alaskan Native
Prefer not to answer
Other
Please select all that apply
Please specify
* must provide value
Handedness
* must provide value
Right
Left
Approximate weight
* must provide value
Please include units (i.e. lb or kg)
Approximate height
* must provide value
Please include units (i.e. ft or cm)
Do you have any metal in or on your body (i.e. orthodontic devices like braces or permanent retainer, surgical/metallic/magnetic/electronic implants, permanent piercings, protheses, tattoos, medical patches)?
* must provide value
Yes
No
Do you feel or tend to feel claustrophobic?
* must provide value
Yes
No
Would you like to complete the more extended survey?
* must provide value
Yes
No