Hidradenitis Suppurativa 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 at least 5 inflammatory HS lesions? *–YesNoUnsure

4. Have you had at least 28-days of antibiotic treatment for your HS? *–YesNoUnsure

5. Have you had at least 3 months of antibiotic treatment for your HS? *–YesNoUnsure

6. Have you previously used the biologic therapy Humira to treat your HS? *–YesNoUnsure

7. Have you previously used the biologic therapy Cosentyx to treat your HS? *–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/NCT05139602?term=NCT05139602&rank=1

https://clinicaltrials.gov/study/NCT05889182?term=NCT05889182&rank=1

https://clinicaltrials.gov/study/NCT05819398?term=NCT05819398&rank=1

https://clinicaltrials.gov/study/NCT05620836?term=NCT05620836&rank=1

https://clinicaltrials.gov/study/NCT06046729?term=NCT06046729&rank=1

https://clinicaltrials.gov/study/NCT03827798?term=NCT03827798&rank=1