VRG Participant Information form

First Name

Last Name

Gender

Age range

Phone

Email

Please check all the areas of Mental/Behavioral Health that you are interested in learning more about:
 Addiction Disorders Anxiety Disorders Bipolar Disorders Borderline Personality Disorder Depression Eating Disorders Obsessive-Compulsive Disorder Post-Traumatic Stress Disorder Schizophrenia Suicide Prevention

Your privacy is important to the Vanguard Research Group. By clicking Submit, you are aware that a Vanguard Research Group representative will contact you to share more information when a potential opportunity to participate is available. Submission of this form does not obligate you in any way.