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:

T4GHifeBwea4z4jE8VsipoHFd4rSvvZ7tXBK5uIRSnL6YI3gfeF2G3D3fcJNgtnfD3wXV3RRqQ6zSjILJE7Hadf9WkoDiusPUCttJDx47u4PV3RxPiT

EN-21 PP/01 Eligibility Survey

Thank you for your interest in our research study for feet pain from diabetes.

If you have pain in your feet from diabetes, you may be eligible for a research study being conducted by University of Rochester. The purpose of this study is to find out if a new study drug helps to treat foot pain from diabetes. This is an investigational drug, which means it has not been approved by the FDA yet. We also want to find out if it works better than placebo. A placebo drug looks like a study drug but does not contain any active ingredients.

Study participation will last for approximately 5 months and includes 7 visits to the research site. The study visits will be 2-4 hours long on weekdays, between 9am-5pm. You will be paid $85 for each completed visit, and reimbursement is available for transportation and dependent care.

The following questions will help us determine if you might be eligible for the study.

Page 1 of 17

You have selected an option that triggers this survey to end right now.

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.