1-855-VIEWVISTA (1-855-843-9847)

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  • STEP 1
  • STEP 2

To help us determine if you / your child may qualify to participate in the VISTA clinical trial, there are a series of questions that are broken into 2 steps.

  • Step 1
    These questions will help us understand the potential participants’ eligibility.
  • Step 2
    If your answers indicate that you or your child may qualify, you will be asked to provide contact information so someone from our nursing staff can contact you.

This should take about three to five (3-5) minutes. We will treat all personal and medical information you provide us as confidential.

This is a required question. Please answer and resubmit.

Myself

Parent of minor child

Legal guardian of minor child

Legally authorized representative of adult

Someone else

This is a required question. Please answer and resubmit.

Please indicate your relationship to the potential study participant.

This is a required question. Please answer and resubmit.

Male

Female

This is a required question. Please answer and resubmit.
This is a required question. Please answer and resubmit.

Yes

No

This is a required question. Please answer and resubmit.