Kessler TBI Study Qualification

Full Name

Email Address

Phone Number (10-digit US)

Date of Birth

Format: Month/Day/Year (e.g., 01/15/1990)

City and State

Experienced TBI at least one year ago?

Yes No

Persistent memory problems?

Yes No

Fluent in English?

Yes No

Handedness

Left-handed Right-handed

Willing and able to exercise?

Yes No

Able to undergo an MRI?

Yes No

Contact for future studies?

Yes No

What types of studies would you be interested in?

List comma separated keywords

Submit Qualification