Netherton Syndrome 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? *–PhysicianFriend or FamilySocial MediaOffice FlyerOther

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

3. Have you been diagnosed with Netherton Syndrome? *–YesNoUnsure

4. Have you completed genetic testing for confirmation of diagnosis of Nether Syndrome? *–YesNoUnsure

5. Do you have active NS lesions on your arms, trunk or legs? *–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/NCT06539507?term=bcx17725-101&rank=1