Cortica Research Interest Form
Participant Gender:
Female
Male
Non-Binary
Participant Sex:
Female
Male
Intersex
Diagnosis or Research Interest
Autism Spectrum Disorder (ASD)
Attention Deficit Hyperactivity Disorder (ADHD)
Tourette's Syndrome / Tic Disorders
Genetic or Rare Syndromes
Developmental or Speech Delay
Anxiety, Depression, or Mood Disorders
Other Neurodevelopmental Condition
Seeking Evaluation/No formal diagnosis
Which of our research locations is most convenient?
Southern California (Glendale, CA)
Northern California (San Rafael, CA)
Other - to discuss with Study Team
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