This is a screening form for our current Complex Regional Pain Syndrome studies.

We are studying two new pain treatments. You may be asked to come to up to 5 sessions, answer daily questions, and complete questionnaires.

The screening questions should take about 15 minutes to complete.
This will help us understand if you may be eligible for one of these specific studies.

Please be assured that your information will be stored SECURELY and NOT SHARED with any third party.

You can choose if you want or do not want to take part in this research screening procedure - it is up to you. If you refuse to answer the questions or stop answering them at any time, there will be no penalty, and you will not lose any benefits to which you otherwise would be entitled.

If you have any questions, concerns, or complaints about this form, contact Protocol Director, Sean Mackey, MD, PhD, at (650) 725-9636.

If you want to talk to someone separate from the research team about a concern or complaint or your rights as a possible research subject, please contact the Stanford Institutional Review Board (IRB) to speak to an informed person who is separate from the research team, at 650-723-5244 or toll-free at 1-866-680-2906.

Thank you for your participation!

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