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* Thank you for your interest in our study from Yale University. The purpose of this survey is to determine your preliminary eligibility for the study. Therefore, this survey includes questions regarding your smoking habits, as well as your medical history. Please feel free to skip any questions that you would rather not answer. However, this may affect your eligibility for the study. Your answers are strictly confidential. Below you will be asked to indicate whether or not you would like to give consent and advance to the survey itself. You will also be asked to provide your email address and a telephone number, which you will enter into the survey. Only our research staff will have access to this information. Your email address and phone number will only be retained for the purpose of contacting you regarding the study. Your email address and phone number will not be provided to any other entity outside of our staff. The consent form and survey are both housed on www.surveymonkey.com, which is a secure website. You must be at least 18 years of age to complete this survey in order to participate. A similar screening can occur over the phone. Please call 203-785-4349 if you would prefer to complete the screening by phone. Please also feel free to email marney.white@yale.edu if you have any questions regarding the study. Thank you very much for your consideration.

By checking this box, I am verifying that I am at least 18 years of age, and I have read and understand the material presented above. I understand that I can print a copy of this page for my records. I am aware that my responses on this survey will remain confidential and that my participation is entirely voluntary.

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