Living with Peripheral T-cell Lymphoma?
Factor in all of your options.

Thank you for your interest in learning more about research studies for individuals with Peripheral T-cell Lymphoma (PTCL). The purpose of this registry is to provide you, your family and loved ones with important information regarding clinical trials taking place in your area.

Please sign up below to receive additional information on how you may be able to participate in these important research studies:


Name
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Address
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Gender
Date of Birth

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Primary Phone
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Have you been diagnosed with Peripheral T-Cell Lymphoma (PTCL)?
Have you relapsed after at least one prior PTCL treatment regimen?
Are you currently taking any prescribed medications for your PTCL?
Are you willing to go to a doctor’s office for additional medical evaluations? (Most studies require occasional travel to a study site)
How far would you be willing to travel to participate in a study?
Have you participated in clinical trials in the past?
Participation Date?

(mm/dd/yyyy)
How did you learn about this volunteer opportunity?
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