Cortica Tourette's Research Interest Form

Cortica Tourette's Research Interest Form

Gender: Female, Male, Non-Binary
Sex: Female, Male, Intersex

Which Cortica Research location is most convenient?

• San Rafael, California (Northern California)
• Glendale, California (Southern California)
• I am not local but would be willing to travel (travel expenses are not reimbursed)

Has the participant been diagnosed with Tourette's Syndrome?

• Yes, I already have a diagnosis from previous physician
• No, I am seeking a diagnosis

Please select any medications tried for tics or Tourette's Syndrome:

• Aripiprazole (Abilify)
• Risperidone (Risperdal)
• Haloperidol (Haldol)
• Pimozide (Orap)
• Guanfacine (Tenex, Intunive)
• Clonidine (Catapres, Kapvay, Onyda XR, Nexiclon XR, Javadin)
• Other(s)

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