Netherton Syndrome Study Application

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Name *

First

Last

Age *

Email *

Phone Number *

Example: 3175165030

1. How did you find us? *–PhysicianStaff ReferralFriend or FamilySocial MediaOffice FlyerOther

2. If you were referred by a staff member, please list name

3. Have you been diagnosed with Netherton Syndrome? *–YesNoUnsure

4. Have you completed genetic testing for confirmation of diagnosis of Nether Syndrome? *–YesNoUnsure

5. Do you have active NS lesions on your arms or lower legs? *–YesNoUnsure

Submit

By submitting your information, you give Dawes Fretzin Clinical Research Group permission to contact you regarding study opportunities.

For additional information on this study please visit:

https://clinicaltrials.gov/study/NCT05521438?term=NCT05521438&rank=1

https://clinicaltrials.gov/study/NCT05789056?term=NCT05789056&rank=1

https://clinicaltrials.gov/study/NCT05902663?term=NCT05902663&rank=1