If you are interested in learning more about the SM Clinical Trials, including how your patient(s) may participate, please call 1-833-411-MYSM (1-833-411-6976) to leave a message or fill out the form below to have a qualified healthcare professional get in contact with you:

How did you hear about the SM clinical trials? (check all that apply)

%field:ext_hear%

This is a required question. Please answer and resubmit.

%field:ext_hear_other%

[Healthcare professionals only] Please provide your contact information so one of our qualified healthcare professionals can contact you regarding one of the SM clinical trials.

%field:first_name%

This is a required question. Please answer and resubmit.

%field:last_name%

This is a required question. Please answer and resubmit.

%field:ext_suffix%

This is a required question. Please answer and resubmit.

%field:email%

This is a required question. Please answer and resubmit.

%field:ext_practice%

This is a required question. Please answer and resubmit.

%field:phone%

This is a required question. Please answer and resubmit.

%field:ext_fax%

This is a required question. Please answer and resubmit.

%field:ext_specialty%

This is a required question. Please answer and resubmit.

%field:ext_address%

This is a required question. Please answer and resubmit.

%field:ext_address_2%

%field:ext_city%

This is a required question. Please answer and resubmit.

%field:ext_state%

This is a required question. Please answer and resubmit.

%field:ext_zip%

This is a required question. Please answer and resubmit.

Submit Your Patient’s Contact Information (Optional)

Thank you for completing the questionnaire.

Please provide contact information for only adult patients 18 or over.

A nurse from the study team will contact your adult patient to review eligibility and provide information about the trial.

%field:ext_p_fname%

%field:ext_p_lname%

%field:ext_p_phone%

%field:ext_p_email%

%field:ext_p_zip%

%field:ext_p_country%

By checking the box below, I understand that the personal information I have provided may be collected, shared, used and/or transferred to the Clinical Trial study team and their representatives for the sole purpose of enabling me (the HCP), and/or the patient I have entered above to be contacted regarding a clinical trial.

%field:ext_certify%

This is a required question. Please answer and resubmit.

• The name and phone number I have provided belong to my patient, are correct, and I attest that the contact person is interested in being contacted regarding a clinical trial (in order to help prevent unauthorized use of this service).
• I confirm that I have read and understood the Privacy Policy.
• The contact person is 18 years or older.
• My patient has agreed to be contacted via phone by Serva Health.

Submit