BioBank Registration Form

Self assessment

* Required
 
Please indicate if you have any of the following diseases.

Note: The presence of any condition besides psoriasis or psoriatic arthritis is a disqualifying factor. Read more about our criteria for participation.

Name of disease Yes No Don't know
* Psoriasis Yes
* Psoriatic arthritis
* Atopic dermatitis
* Cutaneous T-Cell Lymphoma (CTCL)
* Eczema
* Have you ever donated a blood sample to a tissue bank or other psoriasis-related research study?
Yes
No
* Age of participant?
Under 15
15-17
18 or over
 
* Is there a board-certified dermatologist who we can contact to verify your diagnosis?
Yes
No
 
* Is there a board-certified rheumatologist who we can contact to verify your diagnosis?
Yes
No
 


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