Crohns And Colitis Trials » Do You Qualify?

1) What is your email address?

This is a required question. Please answer and resubmit.

2) What is your 4-digit year of birth?

This is a required question. Please answer and resubmit.

3) What is your zip code?

This is a required question. Please answer and resubmit.

4) Please select which of the following best describes your condition:

Diagnosed with Crohn’s Disease (CD)

Diagnosed with Ulcerative Colitis (UC)

Have a chronic inflammatory bowel disease -unclassified (IBD-U), but unsure if it is one of the above (a or b). Also called indeterminate colitis

Not diagnosed with any of the above conditions

This is a required question. Please answer and resubmit.

5) If diagnosed with Ulcerative Colitis, do you know your severity (as defined by Total Mayo Score [TMS])?:

This is a required question. Please answer and resubmit.

7) Please select any and all of the medications you are currently taking (select all that apply):

5-aminosalicylates (5-ASA)

Immunomodulators

Anti-tumor necrosis factor (TNF) therapy

Monoclonal antibodies

Oral corticosteroids

Antidiarrheals

Probiotics

Not taking any medication for IBD/CD/UC

This is a required question. Please answer and resubmit.

8) Please select any and all of the medications you previously (but don’t currently) took (select all that apply):

This is a required question. Please answer and resubmit.

9) I am currently enrolled in a clinical trial

Yes

This is a required question. Please answer and resubmit.

10) Are you willing to undergo a colonoscopy, if one is necessary, in order to participate in a study?

Yes

This is a required question. Please answer and resubmit.

We take the privacy and security of your personal information seriously and employ advanced information security controls to protect it. We only share your identifiable information with third parties if there is a potential match with a clinical trial, if they are bound by a confidentiality agreement, and to the extent necessary to accommodate your request. To read the complete privacy policy, click here.

Find Out if You Qualify?

Answer a few simple survey questions to learn if you qualify for clinical trials in your area.

5-aminosalicylates (5-ASA) drugs include:

Immunomodulators drugs include:

Anti-tumor necrosis factor (TNF) therapy:

Monoclonal antibodies drugs include:

Oral corticosteroids drugs include:

Antidiarrheals drugs include:

Probiotics drugs include:

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