Pediatric Scoliosis Research Study - Pre-Screening Questionnaire

Before We Begin

This questionnaire is filled out by a parent or legal guardian on behalf of a child. Before we collect any information, please confirm: Are you the parent or legal guardian of the child you are enrolling?

Yes, I am the parent or legal guardian No

This questionnaire must be completed by a parent or legal guardian

Thank you for your interest. Because this study involves children, this questionnaire can only be completed by the child's parent or legal guardian, so we are unable to continue. None of your answers or contact details have been collected, and you can close this page. If you are under 18, please ask your parent or legal guardian to visit this page instead.

Parent or Guardian Information

Your full name

Please enter your own name (the parent or legal guardian), not your child's.

Your email address

Your phone number

Please enter a 10-digit US mobile number. We will text a code to it to confirm your submission.

Your child's date of birth

Format: Month/Day/Year (e.g., 03/15/2016).

What city do you and your child live in?

Please enter your city and state (e.g., Brooklyn, NY).

Would you like to be contacted about future research studies that may be a good fit for your family?

Yes No

What types of studies would you be interested in?

List comma separated keywords

General Eligibility

Has your child been diagnosed with scoliosis by a doctor?

Yes No Unsure

Is your child currently between 8 and 12 years old?

Yes No

Has a doctor measured your child's spinal curve — sometimes called a Cobb angle — and told you it falls between 10 and 45 degrees?

Yes No Unsure or I don't know the measurement

Your Child's Medical History

Has a doctor ever told you that your child has a neurological condition — such as a nerve or muscle disorder — or a bone condition other than scoliosis that affects how they move or affects their spine or skeleton?

No Yes — please describe below

Please briefly describe the condition.

Has your child ever had surgery on their spine?

Yes No

Study Participation Requirements

This study involves at least one session with a certified instructor at the start — this can be done online over video (such as Zoom) or in person, whichever works for your family — with the possibility of additional sessions if needed. Are you and your child able to take part in these sessions?

Yes No

The study asks families to complete all prescribed poses every day, three times a day, for the amount of time the instructor gives you. Are you and your child willing and able to follow this daily schedule?

Yes No

The study includes X-rays taken at specific points — such as at study entry (or within the 3 months before joining), at around 4 months, and in some cases at around 8 months. Are you willing for your child to complete these X-rays as part of the study?

Yes No

Study Understanding

Do you understand that taking part in this research study is completely voluntary — meaning you can withdraw your child at any time, for any reason, with no penalty and without affecting your child's regular medical care?

Yes, I understand No, I have questions about this

Do you understand that this is a research study, and that its goal is to learn more about treatments for scoliosis in children — not to replace your child's regular care?

Yes, I understand No, I have questions about this

Is there anything else you would like to share with the study team before they reach out to you?