Strados SHORE Program Enrollment

"*" indicates required fields

Questions with an asterisk * are required.

Patient is entering the study at the following site:*

Patient Name:*

First Last

Hidden

Patient ID*

Study Phone Number*

Not patient’s personal cell, please use the STRADOS Study Phone

Typical Bedtime: *

Please let the patient know that we’ll send the survey link 2 hours prior to bedtime

Hour*

Minute*

AMPM*

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