Welcome

Thank you very much for your interest in our study. We are attempting to assess the efficacy of Ecopipam vs. placebo for the treatment of Tourette's Disorder in children (ages 6 and older), adolescents, and adults. The study is conducted under Dr. Jon Grant at the University of Chicago and involves screening visits and then approximately 15 in-person visits over a period of 30 weeks (7 months). Participants will be compensated for their time and travel. The information you provide here will be kept confidential and will not be used for purposes other than seeing if you or your child are eligible to participate in the study.

If you have additional questions, please call 773-702-5523.

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* 1. Are you filling out this form on behalf of yourself or your child?

If you are filling this form out for yourself, please answer the remaining questions about yourself. If you are a parent filling out this form on behalf of your child, please answer the remaining questions about your child.

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* 2. Have you (or your child) been diagnosed with Tourette's Disorder?

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* 3. Are you (or your child) willing to participate in an approximately 30-week clinical trial where you (or your child) will receive Ecopipam or a placebo?

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* 4. Do you (or your child) understand English and can respond to questions, both verbally and written, in the language?

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