Questionnaire for Potential Subjects

Please fill out this brief questionnaire so that we can better answer your questions. A representative from Shepherd Research will be in contact with you to discuss studies that may be appropriate and available to you.

(Required) indicates a required field

If SCI, please indicate which of the following best describes you:

If ABI, what best describes you:

If MS, please indicate what form of MS you have:

Do you have any other significant medical issues or other diagnoses that we should be aware of, such as high blood pressure, diabetes, cardiac pacemaker, stroke, cardiac disease, skin breakdown, etc.?

Is there a specific area of research that you are interested in, such as drug studies, device studies, cellular studies vs. curative studies or therapy intervention studies?

If you checked "Yes," please tell us what areas of research you are interested in:

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