See If You Qualify

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First Name

Last Name

Email *

Which location is most convenient for you?

What is [YOUR or YOUR CHILD’s age]? Date of Birth MM/DD/YYYY

[ARE YOU or IS YOUR CHILD] experiencing symptoms such as green or yellow eye discharge, eye redness or eye stickiness?

When did [YOUR or YOUR CHILD’s] symptoms start?

Confirm symptoms have started <48 hours ago

Have [YOU or YOUR CHILD] received any eye treatment for conjunctivitis other than regular hygiene (i.e. wiping the eyelid) in the last two weeks?

the received Date

[HAVE YOU or HAS YOUR CHILD] been diagnosed with any form of conjunctivitis in the last month?

[ARE YOU or IS YOUR CHILD] willing to discontinue use of contact lenses and cosmetics on the eyelids and lashes for the duration of the study?

[ARE YOU or IS YOUR CHILD] blind or have vision only in one eye?

[HAVE YOU or HAS YOUR CHILD] experienced any trauma to the eye(s) in the past 3 months?

[HAVE YOU or HAS YOUR CHILD] used any steroid-based eye drops or cyclosporine drops in the past two weeks?

[HAVE YOU or HAS YOUR CHILD] taken any antibiotics in the past two weeks?

Are you willing to visit the study doctor’s office for 3 visits over the next week?

105 Monticello Ave, Suite 101
Charlottesville, VA 22902

See if you qualify