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Participant Interest Form

Thank you for your interest in GeoMind.

Please answer the questions below to help us determine whether a research study may be worth discussing with you by phone.

 

This form does not determine whether you qualify for a study. A member of our study team may contact you to review your answers and explain possible next steps.

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This form is not for emergencies or urgent medical care.

If you are in crisis or may harm yourself or someone else, call 911 or go to the nearest emergency room.

Have you been treated for depression or anxiety, or are you concerned you may have them?
Yes
No
Are you between 18 and 65 years old?
Yes
No
Would you be interested in learning about a paid research study involving an investigational medication?
Yes
No
Would you be willing to visit our clinic in person in Hawthorne, California? Transportation support may be available in select situations.
Yes
No
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