Thank you for your interest in the PASSPORT clinical trial. To find out if you are eligible for this clinical trial, please take a few minutes to complete the following pre-screening questions. All information you provide will be kept confidential and will not be shared without your permission except as required by law. If you meet the pre-screening criteria, please contact a member of the PASSPORT clinical trial team at your nearest clinic.
Are you completing this on behalf of someone? YES NO
Who are you completing this on behalf of?
By ticking this box you agree: That I have read and understood the information in the Privacy Notice and that I have discussed this with the person who wishes to take part in the study. By ticking here you agree that you have their permission to provide their name and contact information and that they have consented to the collection, storage and use of their Personal Data as described within the Privacy Notice. You also agree that you have the person's agreement that their name and contact information can be shared with the chosen clinical trial site.
(That is, PSP without any other neurological conditions such as Alzheimer's disease or Parkinson's disease)YES NO UNSURE
(for example, with a walker)YES NO UNSURE