Thank you for your interest in our Targeted Public Health Study!  We need your help to look at whether there is a link between the naturally occurring arsenic and uranium that is found in groundwater in New Hampshire and whether those chemicals are getting into NH residents.  Please answer the following six (6) questions to start the enrollment process.

* 1. Are you interested in enrolling in the Targeted Public Health Study?

* 2. How did you first hear about the study?

* 3. What is your age?  Please select the appropriate range.

* 4. Does your home have a private well as the primary source of water?

* 5. Are there others in your home (children or adults) who would like to enroll?

* 6. Please provide your contact information so we can give you more details about this study.

* 7. What is the best time to call you to discuss details of the study?