CTCL Research Study Survey

Therapeutics Clinical Research is conducting a clinical research study evaluating an investigational topical medication in combination with light therapy for people living with T-Cell Lymphoma. In order to determine if you pre-qualify for this study, we will ask you a few questions about your condition. You may stop answering at any time and you do not need to answer any questions that make you feel uncomfortable.

All information you provide will be kept strictly confidential and will not be shared without your permission, except as required by law. Please feel free to call us for more information at (858) 571-6800.

By providing your contact information, you agree to receive phone calls, emails and/or texts from Therapeutics Clinical Research.

We are looking for participants who are:
· Male or non-pregnant female, ages 18 and up.
· Living with T-Cell Lymphoma
· In good health with no major medical conditions.

Qualified participants receive:
· Study-related skin examinations by a board-certified study doctor or qualified personnel.
· All study visits and study medications at no cost.
· If qualified, compensation for each completed visits. Total compensation up to $3075 after all visits complete.

Study Involves:
· A time commitment of 6 months.
· 41 visits into our research clinic.

Strictly Confidential
No Insurance Necessary

Question Title

* 1. Tell us about yourself:

Name:

Email Address:

Phone Number:

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* 2. Are you you at least 18 years of age?

Yes

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* 3. If female, are you pregnant, nursing, or planning to be pregnant?

Yes

N/A; I am male

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* 4. Are you diagnosed with T-cell lymphoma?

Yes

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* 5. Have you used a medicated or prescribed treatment for your T-cell lymphoma in the last 3 months?

Yes

Thank you for completing the survey. We will review your information and contact you shortly. If you would like additional information or would like to speak to a staff member directly, please feel free to call us at (858) 571-6800 ext.122.