Psoriasis Study Application

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Name *

First

Last

Age *

Email *

Phone Number *

Example: 3175165030

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

2. Do you (or your child) have a diagnosis of psoriasis? *–YesNoUnsure

3. Do you (or your child) have active psoriasis on your body? *–YesNoUnsure

4. Where is your (or your child’s) psoriasis currently located? *

5. Do you (or your child) have psoriasis covering at least 10% of your body? (10% is about the size of 2 sheets of paper) *–YesNoUnsure

10% is about the size of 2 sheets of paper

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

7. Have you (or your child) 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 www.clinicaltrials.gov and search:

NCT06979453

NCT07116967

NCT07489885

NCT06857942

NCT07362017