See If You Qualify

Answer eight easy questions, and we’ll let you know whether or not you or your loved one might be eligible to participate in the study.

Are you answering this screening for yourself or a loved one? *

Myself
A loved one

What is your full name? *

First

Last

What is your loved one's full name? *

First

Last

What’s your email? *

What’s your phone number? *

Are you between 45 and 75 years old? *

Is your loved one between 45 and 75 years old? *

Have you been diagnosed with basal cell carcinoma within the last 3 years? *

Has your loved one been diagnosed with basal cell carcinoma within the last 3 years? *

Approximately how long ago were you diagnosed?

More than 3 years ago
1-3 years ago
6 months ago
3 months ago
1 months ago or less

Approximately how long ago were they diagnosed?

More than 3 years ago
1-3 years ago
6 months ago
3 months ago
1 months ago or less

Has your basal cell carcinoma been treated?

Has your loved one's basal cell carcinoma been treated?

Are you concerned about a specific growth? (Advised to seek treatment)

This trial requires you to attend up to six (6) in-person study visits over a two-week period. Are you able to do that? *

Which location is most convenient for you? *

San Diego, CA
Snellville, GA
Pflugerville, TX
Houston, TX
Dripping Springs, TX
Rockville, MD
Pittsburgh, PA
Oakbrook Terrace, IL
St. Augustine, FL
Coral Springs, FL
Boca Raton, FL

By clicking "I accept", you understand and agree to the terms of the Privacy Policy. You understand and agree that by selecting the submit button, you give permission to share your responses with the study doctors and staff at the clinical research site that you selected, and that they may contact you to discuss the study further. *

I accept
I do not accept

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I agree

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Carmel, IN 46032