AM I ELIGIBLE?

To learn more and to see if you may be eligible to participate in the RESET-HA Study, take our brief online questionnaire.

You must be 18 to submit this form. If you are under 18, please have this form filled out by your parent or guardian.

For parents or guardians of those under 18, please use your name for the study contact information — but answer the other questions based on your child’s condition.

Please Note: All health-related information you provide will remain completely confidential and will only be used to determine if you may be eligible to participate.

Let’s Begin

By clicking Begin, you agree to provide your health-related information for the purpose of determining if you may be eligible to participate in the RESET-HA Study.