Bladder Pain Research Participant Information Form

What is your age?

Select one. Please note, you must be 18 years old or older to participate in this survey and study. If you are under 18 years old, please consult with a guardian.

Which best describes your current situation?

Please select all that apply.

Interest in participating in an IC/BPS study

Are you interested in signing up for the IC/BPS study at Boston Children’s Hospital? Select one. Selecting "Yes" or "Maybe" will promot the request for your contact information.

Yes, I would like to sign up now

Maybe, I would like more information

No, I would not like to participate

Send me a copy of my responses

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Bladder Pain Research Participant Information Form - BCH