Thank you for your interest in the BEAT-MS study. To see if you may qualify to participate, please answer the following questions. It should take no more than 5 minutes to complete this questionnaire. If you pass the pre-screening questions, you will have the opportunity to provide your contact information so that a member of the BEAT-MS team can contact you, ask more questions, and possibly refer you for a screening visit.

1.
Are you between the ages of 18 and 55? *
2.
Have you taken any of the following medications for relapsing MS in the past 3 years? (check all that apply) *
3.
In the past year, have you had an MS relapse (attack, exacerbation, worsening of MS symptoms that lasts for several days) or new MS findings on MRI, on or off medication? *
4.
Have you had at least one MS relapse (attack, exacerbation, worsening of MS symptoms that lasts for several days) or new MS findings on MRI during the last 3 years while taking one of the medications in question 2? *
5.
Are you able to walk 100 yards (the length of a football field)? It's ok if you need to rest or use a cane, one crutch, or one brace. *
6.
How did you hear about us? (check all that apply) *