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Patient Enrollment

If you stutter or have a family member who stutters and have an interest in possibly participating in a research study, please fill out the below form.  Submitting this form does not obligate you to participate in any of the studies: those underway or those planned for the future.  Also, all submissions are confidential and will not be shared outside of the UCI stuttering group.

By submitting this form, you allow us to gather a cohort of interested patients.  This in itself is a great help, and allows us to design future projects with a specific cohort and question in mind.  When we enroll patients for projects, the first group that we solicit for possible participation is the current UCI stuttering group list of patients.  By submitting this questionnaire, you will be automatically added to this list. 

Thank you for taking the time to fill out this form, and we greatly appreciate your interest.

Your Name:

Your Age:

Your E-mail Address:

A Convenient Phone Number:
 

Any Additional Information: