HAARVI

The code block below illustrates how one might use # and // as comments in your logic and calculations.

This value you provided is not a number. Please try again.

This value you provided is not an integer. Please try again.

The value entered is not a valid Vanderbilt Medical Record Number (i.e. 4- to 9-digit number, excluding leading zeros). Please try again.

The value you provided must be within the suggested range

The value you provided is outside the suggested range

This value is admissible, but you may wish to double check it.

The value entered must be a time value in the following format HH:MM within the range 00:00-23:59 (e.g., 04:32 or 23:19).

This field must be a 5 or 9 digit U.S. ZIP Code (like 94043). Please re-enter it now.

This field must be a 10 digit U.S. phone number (like 415 555 1212). Please re-enter it now.

This field must be a valid email address (like joe@user.com). Please re-enter it now.

The value you provided could not be validated because it does not follow the expected format. Please try again.

Required format:

We are currently seeking individuals who will be available to enroll in our study and perform a blood draw at our clinic in South Lake Union between 8:30am-11:00am Tue-Fri.

Blood draws will continue after vaccination at time points of roughly 1 month, 3 months, 6 months, 1 year and up to 2 years after the initial blood draw.

This is an interest form for the HAARVI study. By signing up, you are expressing interest -- a researcher from the study team will call you to talk through study procedures and confirm your interest. You are welcome to sign up if you are at least 18 years old, have had a confirmed diagnosis of COVID-19 OR have received a COVID-19 vaccine.

Our team is interested in learning more about coronavirus antibodies to develop treatments and vaccines for coronavirus. Participation in the study may involve providing a nasal swab sample or coming in to our clinic at South Lake Union to participate in blood draws starting a minimum of 1 month after your first positive test date. To learn more about the research our team is conducting you can visit our study website at https://www.chulab.org/haarvi.

If you have any questions about the study you may also reach us at haarvi@uw.edu.

First Name

* must provide value

Last Name

* must provide value

Phone Number

Have you tested positive for COVID-19?

Yes

reset

Have you received a COVID-19 vaccine?

Yes

reset

Have you received a COVID-19 booster dose?

Yes

reset

Do you live in the Seattle Metropolitan Area?

* must provide value

Yes

reset

You have selected an option that triggers this survey to end right now.

To save your responses and end the survey, click the 'End Survey' button below. If you have selected the wrong option by accident and/or wish to return to the survey, click the 'Return and Edit Response' button.