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See if I Qualify
Kernel: LB Pre-Screening
"
*
" indicates required fields
Name
*
First
Last
Phone
*
Email
*
Age
*
Please enter a number from
0
to
100
.
Zip Code
*
Please enter a number from
10000
to
99999
.
Which best describes your hairstyle?
*
Please select one:
Long length hair (shoulders or longer)
Medium length hair (jaw/chin to neck)
Short hair
Early stages of balding
Mostly/nearly bald
Completely bald or shaved head
Regardless of whether or not you’re qualified for this study, are you interested in being notified about future opportunities?
*
Please select one:
Yes
No
Communications Consent
*
I agree
If you are qualified for this study, you acknowledge that you may be contacted by phone, text, and/or email as part of your enrollment and participation.
