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

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

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

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

6. 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 www.clinicaltrials.gov and search:

NCT05889182