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:

ZbNXLCHGrKrymrSV5S8BFdvQ8KXC9eX6rQyZWpEgTibNxI7JFrKRRYDLvDwHtysLJi2yaVdrwLF6d5D2y5Um5vGA8FcTwW9FQHXTRncHrcMD2kiLnWsYZxETH6

ASTOR Enrollment Form

Please complete the enrollment survey below.

Once the Web Enrollment survey is completed, you will be automatically redirected to the consent form survey. Please note, you are not considered officially enrolled until the consent forms and phone interview are completed. Please use the following link only once, per individual participant. If you are completing a Web Enrollment Form Survey for yourself and others, such as your children, you will need to use the same initial link (https://redcap.link/qbtr3o0b) to complete the web enrollment form for other individuals, followed by the consent forms. If you have any questions, please contact the study coordinator, Amy Kowalski, at mert0067@umn.edu.

Once you complete the consent forms, you will be contacted by the study coordinator to complete a phone interview.

Have a great day!

Thank you!

alport@umn.edu

First Name

* must provide value

Middle Initial

Last Name

* must provide value

Family Name

Date of Birth

* must provide value

M-D-Y

Sex

Female

Male

Other

reset

Race

American Indian/Alaskan Native

Asian

Black/African American

Native Hawaiian/Pacific Islander

White/Caucasian

Not Specified

Unknown

Ethnicity

Hispanic/Latino

Not Hispanic/Latino

reset

Participant/Guardian Email Address

Re-enter Email Address

Participant/Guardian Phone Number

Preferred Contact

Mail

Telephone

reset

Do you have any children affected with Alport Syndrome?

In which age range(s) are these children?

0-7

8-17

18+

Address Line 1

Address Line 2

City

State

Please tell us what other state

Postal Code

Country

Please tell us what other country

How did you learn about the ASTOR website?

Please describe how else you heard about this website

Physician - Name and Affiliation

Other Comments

Expand

Web Enrollment Form Date

M-D-Y

Mark field as:

[Clear value]

Not available (NAVU)

Unknown (UNK)

Not applicable (NA)

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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.