First Name:
Last Name:
Email:
Age:
Zip Code / Postal Code:
Gender:
Have you been tested for COVID-19?
Are you currently taking any of the following supplements daily or almost daily?
Vitamin C
Vitamin D
Vitamin E
Zinc
Selenium
Are you currently taking any multivitamin?
If yes, what is the brand and how frequently do you take it? (e.g. Centrum Advance, 1/day), If no type none:
My DNA sample may only be stored and used for future research that relates to the clinical area [COVID] being investigated under this study. Choose one:
My specimens may be stored and used to support any future research. Choose one:
I will consider providing consent to use my DNA sample to support future research. Prior to any future research use, please provide me with a consent form that describes the protocol.
My DNA sample may be stored and used for the development of commercial products without any financial compensation to me. Choose one:
  1. Please Read The Informed Consent Here and check the boxes below to participate in the study