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

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

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

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

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.

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

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

9. 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 www.clinicaltrials.gov and search:

NCT07599813

NCT07643766

NCT06807268