Chronic Spontaneous Urticaria Study Application

Please enable JavaScript in your browser to complete this form.

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 symptomatic CSU for more than 6 months? *–YesNoUnsure

4. Have you had the presence of itch and hives for more than 8 consecutive weeks despite current use of H1-antihistamines? *–YesNoUnsure

5. Are you currently taking a stable dose of H1-antihistamines? *–YesNoUnsure

6. Have you previously used omalizumab (Xolair)? *–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/NCT06162728?term=NCT06162728&rank=1