PRE-ENROLLMENT SCREENING QUESTIONNAIRE

This intake allows us to gather the critical health, demographic, and physical activity information needed to ensure your safety for our upcoming wearable device study. You are required to complete this form in order for your enrollment process to begin.

Personal information

First Name

Last Name

Phone Number

Email Address

Date of Birth

Height (cm)

Weight (kg)

Please select your ethnicity

Hispanic or Latino

Not Hispanic or Latino

Not Reported

Unknown

https://storage.tally.so/5d5f2285-119c-46e1-8cac-dd35a9f7ffea/Fitzpatrick-scale.webp

https://storage.tally.so/5b830a27-5e03-40db-aa04-5990fc5a9831/The-photographic-hair-density-scale-utilised-for-assessment-of-forearm-hair-density.webp

Using the image above, how would you describe the hair density on your wrists where the study sensor will be placed?

Nil

Sparse

Moderate

Dense

Please upload two clear photos: one of your LEFT wrist and one of your RIGHT wrist.

For each photo:

Show the skin on the top side of your wrist where the study watch or band sensor will rest. Use bright, even lighting and make sure the skin is in focus.

The study team will review the photos to assess visible hair coverage and whether tattoos, scars, or wounds overlap the sensor placement area.

Please upload each photo in its corresponding LEFT or RIGHT wrist field. Final eligibility will be determined by the study team using the study's eligibility criteria.

Left Wrist

Size limit: 10 MB

Right Wrist

Size limit: 10 MB