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NCT07214974 — Pre-Screening Interest

Trial Pre-Screening Interest Form

Thank you for your interest in our registered clinical research study (NCT07214974). Complete this form so our study team can contact you about potential eligibility screening when recruitment opens (estimated September 2026).

Important: Submitting this form does not enroll you in the study, constitute informed consent, or guarantee participation. Enrollment requires separate eligibility review and an IRB-approved Informed Consent Form. Investigational stem cell therapy and BCI devices are not FDA-approved for this indication. Clinical Trial Information & Disclosures
Your information is handled with discretion. Submissions are reviewed within 72 hours. We do not share your data with third parties or use it for unsolicited marketing.

Trial Pre-Screening Interest

Fields marked with * are required.

Personal Information

Tell us how to reach you and basic demographic details.

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Valid email required
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Study Interest

Select topics relevant to NCT07214974 pre-screening (optional).

Health & Lifestyle

Help us understand your background and daily habits.

Health Background

Help us understand your health background for pre-screening interest (not a clinical evaluation).

Required

Accepted: PDF, PNG, JPG, GIF. Max 10 MB per file.

For Female Patients (optional)

Complete if applicable.

How Did You Hear About Us?

IRB documentation: Pre-screening materials are under IRB review. View IRB Documentation (status: pending).
Pre-screening form version: WEB-PRESCREEN-001 v1.0

If recruitment opens and you may be eligible, the study team may contact you with next steps. Full enrollment requires IRB-approved informed consent and separate screening procedures.

Learn More About the Study

Review full trial information, eligibility summary, and disclosures before expressing interest.

Clinical Trial Information