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

3. Do you have a diagnosis of atopic dermatitis/eczema? *–YesNoUnsure

4. At what age were you diagnosed with atopic dermatitis/eczema?

5. Do you have active atopic dermatitis/eczema on your body? *–YesNoUnsure

6. Where is your atopic dermatitis/eczema currently located? *

7. 6. Do you have atopic dermatitis/eczema covering at least 10% of your body? (10% is about the size of 2 sheets of paper when all your active atopic dermatitis/eczema lesions are combined) *–YesNoUnsure

10% is about the size of 2 sheets of paper when all your active atopic dermatitis/eczema lesions are combined.

8. Have you previously used a prescription biologic (injectable) therapy to treat your atopic dermatitis/eczema? *–YesNoUnsure

9. Have you previously used a prescription topical therapy to treat your atopic dermatitis/eczema? *–YesNoUnsure

10. Do you suffer from sleep loss due to itching from your atopic dermatitis/eczema? *–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/NCT06461897?term=m17-380&rank=1

https://clinicaltrials.gov/study/NCT07011706?term=ATI-045-AD-201&rank=1

https://clinicaltrials.gov/study/NCT07205081?term=atto-3712-101&rank=1

https://clinicaltrials.gov/study/NCT07230860?term=95597528adm2001&rank=1

https://clinicaltrials.gov/study/NCT07265479?term=OG0505-3104&rank=1

https://clinicaltrials.gov/study/NCT06807268?term=b7451023&rank=1

https://clinicaltrials.gov/study/NCT05995964?term=c4531002&rank=1

https://clinicaltrials.gov/study/NCT06863961?term=cs45570&rank=1

https://clinicaltrials.gov/study/NCT06241118?term=efc17599&rank=2

https://clinicaltrials.gov/study/NCT07167758?term=triv-509-101&rank=1