Psoriasis 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. Do you have a diagnosis of psoriasis? *–YesNoUnsure

4. Do you have active psoriasis on your body? *–YesNoUnsure

5. Where is your psoriasis currently located? *

6. Do you have psoriasis covering at least 10% of your body? *–YesNoUnsure

10% is about the size of 2 sheets of paper

7. Have you previously used a prescription biologic (injectable) therapy to treat your psoriasis? *–YesNoUnsure

8. Have you previously used a prescription oral therapy to treat your psoriasis? *–YesNoUnsure

Submit

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

For additional information on these studies, please visit:

https://clinicaltrials.gov/study/NCT06073119?term=NCT06073119&rank=1

https://clinicaltrials.gov/study/NCT06088043?term=NCT06088043&rank=1

https://clinicaltrials.gov/study/NCT06088199?term=NCT06088199&rank=1

https://clinicaltrials.gov/study/NCT05172726?term=NCT05172726&rank=1