NCCR Adolescent Asthma Study Qualification

Participant's Full Name

Parent/Guardian's Full Name and Surname

Primary email

Primary contact number

Your City and State

Participant's date of birth

Format: Month/Day/Year (e.g., 01/15/2010)

Has the participant been diagnosed with asthma for at least 3 months?

Yes No

Is the participant using a daily steroid control inhaler?

Yes No

Are you able to attend 5 morning study visits (1 visit = approximately 8 hours) over 2-4 weeks in Raleigh, North Carolina?

Yes No

If you do not meet the criteria for this study, do you consent to be contacted for future studies that might match your criteria?

Yes, I consent to being contacted for future opportunities No, I don't consent to be contacted for future studies

What studies would you be interested in?

Submit Qualification