Thank you for your interest in participating in the LEGATO study at the ITG. 
By completing this questionnaire you can register for this study. If you are eligible to participate, we will call you no later than mid December to schedule your first visit.  

Check here if you meet the most important conditions of participation: 
[* mandatory fields] 

Are you at least 65 years old? *
Are you currently in generally good health? *
Do you have a medical condition? (stable, chronic conditions are allowed) *
Are you taking any medications for this?
Did you already receive a COVID-19 vaccine? *
What vaccination schedule did you receive? *
Did you receive your last injection at least 6 months ago? *
Did you already receive a flu vaccine this season? *
Did you recently receive another vaccine? *
Women: Are you currently pregnant or breastfeeding? *
Women: Are you willing to use a properly functioning contraceptive until 3 months after the last study vaccination? *
Did you have a diagnosis of cancer in the past 5 years? *
Have you ever had an allergic reaction after receiving a vaccine? *
Have you had a major surgery in the past 4 years? *
Are you scheduled to have surgery during the course of the study? *
Are you currently participating in a medication study? *
Have you received study medication in the past 30 days? *
Are you currently participating in another vaccination study? *
Have you received a study vaccine in the past 6 months? *
Are you willing and able to fill out a diary via a study specific app during the vaccination period? *
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