COVID-19 Study: Refer a Friend

Thank you for helping to advance COVID-19 research. Individuals who have recently been diagnosed with COVID-19 may be eligible to participate in the COVID-19 Study.

We will send one e-mail about the COVID-19 study to each person that you refer. For every friend who participates in the study, you’ll receive a $5 Amazon eGift Card.

Your contact information

Referrer’s Name: *

Referrer’s E-mail address: *

Friend #1

First and Last Name: *

E-mail address: *

Friend #2

First and Last Name:

E-mail address:

Friend #3

First and Last Name:

E-mail address:

Friend #4

First and Last Name:

E-mail address:

Friend #5

First and Last Name:

E-mail address:

If the questionnaire fails to submit, please try a different browser (such as Google Chrome).

Captcha