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. By providing your phone number and clicking “Submit” below, you consent to receive messages, including SMS/MMS text messages, sent by or on behalf of AutoCruitment, with information about research studies for which you may be eligible. By clicking Submit, you also agree to our
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Do you consent to the collection and processing of your personal data (including information about your race and ethnicity (as applicable), and your health information, including symptoms, diagnoses, medications, and treatments and our sharing of this information for the purpose of recruitment into clinical research studies, determining your eligibility for studies, and provision of other services you requested? *
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First Name *
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Last Name *
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Phone Number *
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Email
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Date of Birth MM/DD/YYYY *
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Zip Code or Postal Code *
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Are you Male or Female? *
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Female
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Prefer not to say
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Have you been experiencing osteoarthritis in one of your shoulders for at least 3 months? *
Please select one...
Yes - experiencing osteoarthritis
No
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How many days per month do you experience pain in your shoulder due to osteoarthritis? *
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Do you experience persistent pain in BOTH shoulders due to a diagnosed medical condition? *
Please select one...
No - pain in one shoulder only
Yes - pain in both shoulders
Unsure
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Do you have any surgical hardware in your shoulder? *
Surgical hardware includes plates, pins or screws.
Please select one...
Yes - surgical hardware
No
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Have you been diagnosed (
by a doctor
) with any other medical conditions? *
(For example: rheumatoid arthritis, gout, lupus, inflammatory bowel disease, asthma, depression, psychiatric illness, COPD).
Please list here or write 'none'.
Please only include conditions which have been diagnosed by a doctor.
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Have you been diagnosed (
by a doctor
) with any
other
chronic pain conditions? *
Chronic pain lasts for over three months and may come and go. It can happen anywhere in your body. This is separate from the pain you experience from your shoulder osteoarthritis.
Please select one...
Yes - I was diagnosed with another chronic condition less than 1 month ago
Yes - I was diagnosed with another chronic condition more than 1 month ago
No
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Are you still experiencing pain from this chronic pain condition? *
Please select one...
Yes
No
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Are you taking any medications for your shoulder osteoarthritis or other health conditions? *
Please list them below or type ‘none’.
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Please, select your height from the dropdown below. *
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How much do you weigh in Lbs (pounds)? *
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Which racial or ethnic group(s) do you identify with? *
Please select all that apply.
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