All information voluntarily provided by you on this form will be kept confidential and will be securely transmitted and handled per Study Protocol guidelines.  We will not disclose your personal information to a third party without your consent, unless we are required or authorized to do so by law or other regulation.

How tall are you (in feet and inches)?

The following medical history information is needed in order to properly assess your qualification to participate in the Mac Study conducted by Loma Linda University and will be used per Study Protocol guidelines.

Do you have any of the following health conditions?