Plaque Psoriasis

Plaque Psoriasis Clinical Trials

Help us research potential new treatment for moderate-to-severe plaque psoriasis

We are looking for adults to take part in clinical trials assessing investigational medication that may be better at treating plaque psoriasis.

You may qualify if:

You’re 18 years of age or older
You have been diagnosed with eczema for at least 6 months
Your plaque psoriasis covers ≥10% of your body

Study benefits include:

Supervision by trained doctors and medical staff
Study-related care and investigational medication provided at no cost
No insurance is needed
Reimbursement may be provided to cover study-related expenses
Convenient site near you

Fill out this short questionnaire to determine if you pre-qualify. You’ll be contacted by medical staff who can answer your questions before you decide to participate.

If after talking to the study coordinator you decide to participate in the study, you will be asked to read and sign a consent form which provides detailed information including your rights, risks, benefits, and requirements of the study.

Fields marked with an * are required.

Do you consent to the collection and processing of your personal data (including information about your race and ethnicity (as applicable), and your health information, including symptoms, diagnoses, medications, and treatments and our sharing of this information (“Health Data”) for the purpose of recruitment into clinical research studies, determining your eligibility for studies, and provision of other services you requested, and disclosure to our Research Partners? You may withdraw your consent at any time by contacting us at info@autocruitment.com. Please note that your revocation will not impact any records or health data already collected, disclosed, or processed based on your consent. If you do not consent to the collection and use of your Health Data in this manner, we will not be able to provide you with our services or evaluate your eligibility to participate in the studies. *

Yes

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Do you consent to receive recurring messages at the phone number you provided above, including SMS/MMS text messages, sent by or on behalf of AutoCruitment through the use of an autodialer or artificial intelligence with information about research studies for which you may be eligible. To opt out, reply “STOP” or similar words. Message and data rates may apply. By clicking ”Yes”, you also agree to our SMS Terms. *

yes no

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By clicking “I accept” below, you agree to receive calls or text messages from or on behalf of Velocity Clinical Research, Inc., regarding clinical research study opportunities at the phone number provided. These calls or text messages may result in data usage and/or charges. Frequency of texting may vary. You may reply with STOP to a text message. For full details, refer to Velocity's Privacy Policy. *

I Accept

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If you are under the age of majority (the age at which a person becomes an adult and has full legal rights and responsibilities), you should not directly enter any information, and your legal parent or guardian should give their consent and enter this information on your behalf. If you are under the age of 13 (or 16 if you are in California or in Europe), and we become aware that you provided this information, rather than a parent or guardian, we will delete such information.

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Personal Information

First Name of Potential Participant *

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Last Name of Potential Participant *

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Phone Number to contact *

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Email to contact *

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Date of Birth MM/DD/YYYY of Potential Participant *

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Zip Code of Potential Participant *

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What is the assigned gender at birth of Potential Participant? *

Male

Female

Prefer not to say

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Health History

Has the Potential Participant been diagnosed by a doctor with any of the following conditions? *

Atopic Dermatitis

Plaque Psoriasis

Chronic Spontaneous Urticaria

Celiac Disease

Primary Immunodeficiency Disease (PID)

Alopecia Areata

Vitiligo

None of the above

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Do you have any spots on your skin that may be suspicious for melanoma (a spot on the skin that is new or changed in size, shape or color)? *

No

Yes – spots on skin that may be suspicious for melanoma

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When has the Potential Participant been diagnosed with any of the following conditions? *

Diagnosed with atopic dermatitis over a 1 year ago

Diagnosed with plaque psoriasis over 6 months ago

Diagnosed with chronic spontaneous urticaria over 6 months ago

Unsure

None of the above

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Considering the last 12 months, has the Potential Participant maintained a gluten free diet? *

Yes – gluten free diet No

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Does your atopic dermatitis or plaque psoriasis cover 10% or more of your body? *
10% of your body is roughly the size of ten palm prints, including fingers.

Yes – covers 10% or more

No

Unsure/Not Applicable

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Has the Potential Participant been diagnosed (by a doctor) with any other medical conditions? *
(For Example: xanthinuria, Cushing’s syndrome, hepatitis, HIV, pancreatitis, cancer, liver disease, schizophrenia, schizoaffective disorder, bipolar disorder)
Please list here or write 'none'.
Please only include conditions which have been diagnosed by a doctor.

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Is the Potential Participant taking any medications or treatments for their health conditions? *
Please list them below or type ‘none’.

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Additional Details

Which racial or ethnic group(s) does the Potential Participant identify with? *
Capturing information on ethnic backgrounds allows us to better understand how different groups may have different needs.
Please select all that apply.

American Indian or Alaskan Native

Asian

Black or African American

Hispanic Latino or Spanish

Middle Eastern or North African

Native Hawaiian or Other Pacific Islander

White

Mediterranean (Greek/Italian/Portuguese/Spanish/etc)

Another race or ethnicity

I prefer not to answer

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First Name of caregiver/parent to contact (if signing up on behalf of potential participant) *

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Last Name of caregiver/parent to contact (if signing up on behalf of potential participant) *

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What is the best day/time to reach you via telephone (we know you are busy)? *

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The information you are providing here will be processed in accordance with our Privacy Policy, which describes our data privacy practices, including how we share your information with our Research Partners and use your information to send you details about potential clinical trial opportunities. When you submit this information, you consent to AutoCruitment’s use of your data as described in our Privacy Policy. If you have any questions regarding the handling of the information you have provided to AutoCruitment, or if you would like to make any changes or withdraw your consent, please contact us at info@autocruitment.com.

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