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IBD Clinical Trial Candidacy

Dear Sir or Madam,


If you would like to be considered for a clinical trial in IBD, please take a few minutes of your time to completethe following questionnaire to see if you are a candidate.

Secured
Survio
Mount Sinai IBD Clinical Trial Candidacy
1

From what type of IBD are you suffering?

2

For how many years have you been dealing with this diagnosis?

Select one answer
3

Have you experienced any of the following complications?

Select one or more answers
4

Which class of medications have you been on in the past?

Select one or more answers
5

Please provide your name and phone number so we can contact you for more information.