Archive:
Refer TEST
%field:ext_hear% %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.…
DNQ Reasons
Not diagnosed with Systemic Mastocytosis (SM) or experiencing any symptoms Under 18 years of age Incapable of any selfcare and totally confined to a bed or chair
Screener
How did you hear about the SM clinical trials? %field:ext_q1%This is a required question. Please answer and resubmit. %field:ext_q1_other% 1. What is your relationship to the potential study participant? %field:ext_q2%This is a required question. Please answer and resubmit. 2. Please indicate your date of birth. %field:dob%This is a required question. Please answer and resubmit. 3.…
Refer Patient
Learn More about the Systemic Mastocytosis (SM) Clinical Trials (Healthcare Professionals Only) 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:…
Screen Qualified
Please submit your contact information Thank you for completing the questionnaire. It appears you may qualify for the clinical trial. Please only provide your contact information in the form below and please click the submit button. A nurse from the study team will contact you to review eligibility and discuss the clinical trial. Please, do…
Future Studies
You may be eligible for future clinical trials! Although you did not qualify for this trial at this time, you may be eligible for this trial or future SM trials. If the specific requirements for this study change or a new study is available, may we retain the information you provided and have your name…
Yes – Disclaimer
Yes, I would like to be contacted about future clinical trials. I have read, understood and accept the Privacy Policy, and I authorize the sponsor of the clinical trial and its contracted third parties to process my personal and health information as described. Please, do not provide any information about anyone but yourself.