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BioBank Registration Form

Self assessment

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

Note: The presence of any condition is a disqualifying factor. Read more about our criteria for participation.

Name of disease Yes No Don't know
* Psoriasis No
* Psoriatic arthritis No
* Alopecia areata
* Atopic dermatitis
* Crohn's disease
* Cutaneous T-Cell Lymphoma (CTCL)
* Eczema
* Juvenile-onset diabetes (type I)
* Lupus
* Multiple sclerosis
* Rheumatoid arthritis
* Ulcerative colitis
* 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
 


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