Participant Screening Form

We will need to ask you a few questions in order to determine whether you may be eligible for the research. These include questions about your education and medical history. First we would like to tell you a little about our research.

This research is being done to study transcranial Direct Current Stimulation, or tDCS and transcranial Alternating Current Stimulation (tACS), on healthy people to determine the brain-basis of reasoning. TDCS/tACS is a technique by which small electric currents are applied to the scalp, which will allow investigation of the causal role of the brain area to which tDCS/tACS was applied in the behavioral task performed. If you are eligible, the research will include a brief online survey, and a single visit to the lab for computer-based behavioral tasks and tDCS/tACS.  No medications or invasive procedures are involved. TDCS and tACS requires you to sit while a cap with several circular gel-filled discs are placed on your head. A small portable machine that is connected by thin wires to the pads passes a very small current. The current will be present for up to 30 minutes. Risks and side effects of the study that may occur include mild tingling, itching, redness, or pain in the skin under the pads. Fatigue is less likely to occur.

You may feel uncomfortable answering questions about your education, medical, and psychiatric history. You do not have to answer any questions you do not wish to answer and you may stop at any time.  Your participation in the screening is voluntary.  A decision whether or not to participate in the screening will not affect your relationship with Loyola University Chicago. You will not directly benefit from the screening.

If you do not qualify for the study, your answers during this screening will be destroyed.

If you qualify for an appointment, your answers will be kept with the research record if you decide to participate in the research project and sign the research informed consent form.

During this screening, we will collect information about you in this study. This information will include your name, birth date, and information regarding your educational, medical and psychiatric history. Your information is being used to be able to contact you if you are eligible and decide to participate in the research study. People at Loyola University of Chicago who are involved in the study or who need to make sure the study is being done correctly will see the information.  These people will use your information for the purpose of the study.

We try to make sure that your answers to these questions are kept confidential but we cannot guarantee this.