Please complete the following medical screening questions below to determine your eligibility. Your information will not be shared with third parties and will remain private.

Please read our privacy policy for more details.

Thank you for your interest in this research study.

Please Note: You do not have to answer any particular question. However, your responses will be used to determine if you are a good match for our research study.



How did you find out about this study opportunity?

What is your name?
First MI Last

What is your date of birth?
dd-mm-yyyy  

What is your zip or postal code?

Have you had a previous preterm delivery?
   

Are you currently pregnant with one baby?
  

Are you currently less than 20 weeks pregnant?
  

Approximately how many weeks pregnant are you?

Have you had any progesterone hormone treatments in any form (i.e., vaginal, oral or injections with a needle) during your current pregnancy?
      

Have you taken any blood thinners, in any form other than oral, during your current pregnancy?
     

Have you ever been told by your doctor that you have blood clots?
        

Do you currently have a surgical stitch in your cervix?
        

Do you have high blood pressure that requires medication?
        

Has your doctor told you that you have a seizure disorder?
        

Have you participated in a research study in the last 30 days?