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Ejprz4He3mk9JQ9nWVzH

Twin Brains Registration

Returning?

A A A

Registration for the Twin Brains Study

If your twins/multiples are currently in grades 3-8 (or will be next fall), your family may be eligible to participate in the Twin Brains Study at the University of Texas. Our research team is interested in how life events and circumstances contribute to children's brain development and academic success. Your family can earn up to $200 by participating in our study ($100 per twin/multiple).

If your family agrees to participate, you will be asked to complete a survey and bring the twins/multiples to our lab at UT for up to two visits. During the first visit, your children will fill out a survey and take tests that measure a variety of abilities. We will also collect a small hair sample (about the width of a matchstick) to test the levels of certain hormones. If your children are eligible for the second visit, they will watch a movie and play games while our team takes pictures of their brains.

Our lab uses Magnetic Resonance Imaging (MRI) to take pictures of the brain. MRI does not use x-rays or radiation; it uses a magnetic field and radio waves to build images. The risk of having an MRI is not greater than risks children experience in everyday life. Each child will receive a picture of their brain if they participate in the MRI visit.

If you are interested in participating in either Visit 1 (survey and cognitive tests) or Visit 2 (MRI scan and games), please fill out the information below. After you sign up, we will contact you to answer any questions you might have about participating and to schedule an appointment to visit the lab. Please let us know if you have any questions prior to enrolling by emailing the lab at twinbrainsUT@gmail.com or calling 512-471-1406.

Parent First & Last Name(s)

Street Address

City

State

Zip Code

Home Phone Number

Cell Phone Number

Email Address

Twins' Date of Birth

Y-M-D

Twins' Last Name

I think that the twins are:

Identical

Fraternal

I don't know

reset

What category or categories best describes the twins' race? (Choose all that apply)

White

Hispanic/Latino

Black/African-American

Asian

Other

The following items refer to the twin that was born FIRST:

First Name

Sex

Male

Female

reset

Has Twin 1 begun menstruation?

Yes

reset

Is Twin 1 currently on any form of hormonal birth control?

Yes

reset

What grade is this twin in (if it is summer, what grade will he/she enter in the fall)?

What school does he/she attend (if it is summer, what school will he/she enter)?

The following items refer to the twin that was born SECOND:

First Name

Sex

Male

Female

reset

Has Twin 2 begun menstruation?

Yes

reset

Is Twin 2 currently on any form of hormonal birth control?

Yes

reset

What grade is this twin in (if it is summer, what grade will he/she enter in the fall)?

What school does he/she attend (if it is summer, what school will he/she enter)?

How did you hear about the study?

I received a letter or phone call.

I heard about the study from a friend.

I found the website when browsing the Internet.

I saw the Twin Project commercial.

Other

reset

Which part(s) of the study is your family willing to participate in or hear more about? (Check all that apply)

Visit 1: Child survey and cognitive tests

Visit 2: MRI scan and games

Major medical, neurological, psychological, or hormonal (endocrine) disorder

Twin 1

Twin 2

Neither twin

Please describe

Expand

Medication taken for reasons other than cold, flu, allergy, or headache (please be sure to note steroid based medication in particular)

Twin 1

Twin 2

Neither twin

Braces or other extensive dental work (permanent retainer, spacers, palate expander)

Twin 1

Twin 2

Neither twin

Operations or surgeries

Twin 1

Twin 2

Neither twin

Type of procedure, approximate month & year, outcome (was it resolved?), and ongoing medical care.

Expand

Ear surgery or cochlear implant

Twin 1

Twin 2

Neither twin

Heart pacemaker or valve

Twin 1

Twin 2

Neither twin

Metal clips from surgery

Twin 1

Twin 2

Neither twin

Nerve stimulator implant (T.E.N.S unit)

Twin 1

Twin 2

Neither twin

Implanted infusion pump for insulin or other medication

Twin 1

Twin 2

Neither twin

Other implant

Twin 1

Twin 2

Neither twin

Enter the model, approximate month and year of implantation, and ongoing medical care.

Injury (especially to the eye) involving a metal object

Twin 1

Twin 2

Neither twin

Glasses or contact lenses

Twin 1

Twin 2

Neither twin

Strabismus (crossed eyes, either now or earlier in life)

Twin 1

Twin 2

Neither twin

Hearing problem

Twin 1

Twin 2

Neither twin

Concussion with loss of consciousness

Twin 1

Twin 2

Neither twin

Heart arrythmia, irregular heartbeat, or other heart problem

Twin 1

Twin 2

Neither twin

Body piercing that cannot be removed

Twin 1

Twin 2

Neither twin

Admitted to a hospital after birth for any reason not described above

Twin 1

Twin 2

Neither twin

Any other medical or psychological problem not listed above (e.g., history of seizures, claustrophobia)

Twin 1

Twin 2

Neither twin

Expand

Optional: You can use the space below to include a message to us, including information about additional multiples.

Expand

You have selected an option that triggers this survey to end right now.

To save your responses and end the survey, click the 'End Survey' button below. If you have selected the wrong option by accident and/or wish to return to the survey, click the 'Return and Edit Response' button.