• This form is used to gather information about individuals who may be interested in participating in a research study being conducted by Life University's Center for Chiropractic Research (CCR). All responses are protected and stored on a HIPPA compliant server. Please complete all items. Thank you.

  •  -
  •  -  -
    Pick a Date
  • The next three questions provide some information that are important for studies that investigate interactions with our physiology. 


  • Should be Empty: