CANNHeart Study Qualification - University of Miami

Full Name

Email Address

Phone Number

Your city and state

Date of Birth

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

Sex assigned at birth

Male Female Intersex

Do you know your HIV status?

HIV positive HIV negative Unsure of status

Are you currently on a stable antiretroviral therapy (ART) regimen for at least 6 months?

Yes No

Can you communicate in English or Spanish, and are you able to give consent?

Yes No

Have you ever used cannabis?

Yes No

Have you used cannabis in the past year?

Yes No

Do you currently use cannabis at least once a week?

Yes No

Do you have any of the following medical conditions? (Select all that apply)

Are you currently pregnant (self-report or urine pregnancy test)?

Yes No Not applicable

Do you take any prescription medication for glucose?

Yes No

Thank you for your time. If do not meet the criteria to enroll into this particular study would you like us to contact you again if another study comes up for which you might qualify to participate in?

Yes No

Future Study Interests