Am I Eligible?

To make an initial assessment of your eligibility to participate in this clinical research study, we would like you to complete this questionnaire consisting of 7 questions.

Completing this questionnaire does NOT obligate you to participate in this study.

If your answers indicate that you may be a good candidate for the study, you will be asked to provide your contact information so our clinical team can contact you with further details about the study and to discuss your eligibility in more detail.

If you do not qualify based on your responses, you will receive immediate feedback.

1 How old are you?

This is a required question. Please answer and resubmit.

2 What is your gender?

Male

Female

Prefer not to disclose

This is a required question. Please answer and resubmit.

3 Have you ever been diagnosed with Primary Sclerosing Cholangitis (PSC)?

Yes

No

This is a required question. Please answer and resubmit.

4 Do you currently suffer from itch?

Yes

No

This is a required question. Please answer and resubmit.

5 How would you rate your itch over the past two months?

Mild itch

Moderate itch

Severe itch

This is a required question. Please answer and resubmit.

6 If you qualify and choose to join the study, would you be willing to record your itch score on an electronic diary (like a phone device) once every day? The assessment will take less than 2 minutes to complete. Is this something that you are willing to complete?

Yes

No

This is a required question. Please answer and resubmit.

7 Please enter your zip code so that we can find the nearest study center:

This is a required question. Please answer and resubmit.

Share This Opportunity