The code block below illustrates how one might use # and // as comments in your logic and calculations.

This value you provided is not a number. Please try again.

This value you provided is not an integer. Please try again.

The value entered is not a valid Vanderbilt Medical Record Number (i.e. 4- to 9-digit number, excluding leading zeros). Please try again.

The value you provided must be within the suggested range

The value you provided is outside the suggested range

This value is admissible, but you may wish to double check it.

The value entered must be a time value in the following format HH:MM within the range 00:00-23:59 (e.g., 04:32 or 23:19).

This field must be a 5 or 9 digit U.S. ZIP Code (like 94043). Please re-enter it now.

This field must be a 10 digit U.S. phone number (like 415 555 1212). Please re-enter it now.

This field must be a valid email address (like joe@user.com). Please re-enter it now.

The value you provided could not be validated because it does not follow the expected format. Please try again.

Required format:

8Q8jPQcIervcaU7o44qfhtCvy9wHfH9qinpYu74NGZmcqsx945UwCar7xXS4ciuZ86QuVurGawSrU8QnUIokjbhnGYWcWE6IoNRRzJPcY4NFZK

Contact Form

Thank you for your interest in the TReC study! To learn more about the study, please share your contact information and the study team will contact you within 2-3 business days.

This study includes 8 sessions of CBIT therapy. To learn more about CBIT therapy, please visit: https://tourette.org/research-medical/cbit-overview/

Participant
Name			Preferred Contact Method
Contact	Email:	Phone Number:
Age		Does the participant currently wear braces?
Parent
Name			Preferred Contact Method
Contact	Email:	Phone Number:

This study is open to enrollment at two sites. Select the location you plan to participate for in-person activities, including imaging.

* must provide value

University of Minnesota (UMN) - Minneapolis, Minnesota

University of California, San Diego (UCSD) - La Jolla, California

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Who will be the main contact for the duration of the study?

**if both parent and participant will need to be contacted during the study, select both options**

Parent / Guardian

Participant

A phone interview is required before participation in this study. Please specify three dates with time ranges you would be available for a 30 minutes phone interview.

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Recruitment Source (How did you first hear about the study?)

Mental Health Professional

Physician Referral

Study Flyer/Poster

Event

Family/Friend

Social Media

Other

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Enter referring physician's information

Physician/Mental Health Professional Name
Specialty
Address Line 1
Address Line 2
Address Line 3
City
State
Zip Code

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To save your responses and end the survey, click the 'End Survey' button below. If you have selected the wrong option by accident and/or wish to return to the survey, click the 'Return and Edit Response' button.