SurveyMonkey Powered Online Survey

Welcome to MindMate Research!

Many studies end early because there are not enough volunteers. We help by matching you with research studies. More information about the eligibility criteria for this study:

- Male or female

- 18-65 years of age

- If you qualify and complete the study you may be compensated for your time and travel

Your name and contact information will not be shared and your answers will remain confidential. We will not use your information for any purpose other than to screen you for potential participation in a research study.

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1. Have you been diagnosed with PTSD?

Yes

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2. How long have you been experiencing your symptoms of PTSD?

Less than 6 months

6 months or more

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3. Have you experienced or witnessed a traumatic event within the past 9 years?

Yes

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4. If you answered yes to the previous question, how old were you when you experienced this trauma?

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5. Do you experience unwanted memories, flashbacks, fear, anxiety, isolation, and avoidance?

Yes

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6. Please list any medications you are currently taking for your PTSD (if none, please put "N/A")

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7. Has a physician, doctor or other mental healthcare professionals ever told you that you have any of the following?

Depressive episode with psychotic or catatonic features

Anxiety disorder, social anxiety disorder

Bipolar disorder or any manic, hypomanic, or mixed episode

Schizophrenia, schizoaffective, or other psychotic disorder

Obsessive-Compulsive disorder

Panic disorder

Delirium

Bulimia or Anorexia Nervosa

Mental retardation, delirium, dementia, amnesia or any cognitive disorders

Borderline or antisocial personality disorder

Psychosis

Unsure

None of these apply

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8. What other medications, if any, are you taking at this time? (If none, please type "none)

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9. Do you have a history of drug or alcohol abuse?

Yes

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10. How tall are you in feet and inches?

Feet

Inches

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11. How much do you weigh in pounds?

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12. What is your date of birth (please use the following format MM/DD/YYYY)?

What happens next?

Our research partner will email or call you to complete your assessment and answer any questions you may have. This assessment is free and confidential, and you are under no obligation to participate in the study.

MindMate Research

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1. Have you been diagnosed with PTSD?

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2. How long have you been experiencing your symptoms of PTSD?

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3. Have you experienced or witnessed a traumatic event within the past 9 years?

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4. If you answered yes to the previous question, how old were you when you experienced this trauma?

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5. Do you experience unwanted memories, flashbacks, fear, anxiety, isolation, and avoidance?

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6. Please list any medications you are currently taking for your PTSD (if none, please put "N/A")

Question Title

7. Has a physician, doctor or other mental healthcare professionals ever told you that you have any of the following?

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8. What other medications, if any, are you taking at this time? (If none, please type "none)

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9. Do you have a history of drug or alcohol abuse?

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10. How tall are you in feet and inches?

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11. How much do you weigh in pounds?

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12. What is your date of birth (please use the following format MM/DD/YYYY)?

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13. What is your first name?

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14. What is your last name?

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15. What is your email?

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16. What is your phone number?

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17. What is your ZIP/Postal code?

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18. What is a good time for the researcher to contact you?

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19. Anything else you would like to tell the research team?