Health profile
What is your primary condition of concern? *
Select your main condition...
Eczema / Atopic Dermatitis
Psoriasis
Psoriatic Arthritis
Chronic Hives / Urticaria
Hidradenitis Suppurativa (HS)
High Triglycerides
High Cholesterol
Type 2 Diabetes
Heart Disease / Cardiovascular
Fatty Liver / MASH / NASH
Migraines
Obesity / Overweight
Lupus (SLE)
Rheumatoid Arthritis
Other
Do you have any additional conditions? (select all that apply)
Eczema / Dermatitis
Psoriasis
Psoriatic Arthritis
Chronic Hives
Hidradenitis Suppurativa
High Triglycerides
High Cholesterol
Type 2 Diabetes
Heart Disease
Fatty Liver / MASH
Migraines
Obesity / Overweight
Lupus
Rheumatoid Arthritis
COPD
Crohn's / IBD
Alopecia (Hair Loss)
Vitiligo
Kidney Disease
Depression / Anxiety
Sleep Apnea
Acid Reflux / GERD
Gout
Asthma
Other condition
A few more details
Skin condition details
What % of your body is affected?
Select... Less than 5% 5-10% 10-20% 20-50% More than 50% Not sure Which body areas are affected?
Head/Neck
Arms
Hands
Chest/Back
Legs
Feet
Have topical treatments (creams/ointments) controlled your condition?
Select... Yes, well controlled Partially — still have flares No — not effective Never tried topicals
HS details
HS lesions in at least 2 body areas?
Select... Yes No Have you tried oral antibiotics for HS for 12+ weeks?
Select... Yes, didn't work well Yes, worked well No Currently on Humira or another biologic for HS?
Select... Yes — Humira Yes — other biologic No
Migraine details
How many migraine days do you have per month?
Select... 1-3 4-7 8-14 15+ Are your migraines related to your menstrual cycle?
Select... Yes No N/A
Liver condition details
How was it diagnosed?
Select... Liver biopsy Ultrasound / MRI / FibroScan Blood test Doctor told me Not sure
Family medical history
Do any immediate family members (parents, siblings) have:
Heart Disease
Diabetes
Cancer
Autoimmune Disease
Crohn's / IBD
Psoriasis / Eczema
Can you travel to our site in Philadelphia or Pennington, NJ for regular visits?
Select... Yes — Philadelphia Yes — Pennington, NJ Yes — either location Not sure No — too far
General health questions
These help us determine your eligibility across all studies
Are you currently pregnant or breastfeeding?
Yes
No
N/A
Have you been diagnosed with cancer in the past 5 years?
Yes
No
Have you had an organ transplant?
Yes
No
Do you have HIV, Hepatitis B, or Hepatitis C?
Yes
No
Are you currently on dialysis?
Yes
No
Have you had surgery in the past 30 days?
Yes
No
Are you currently enrolled in another clinical trial?
Yes
No
Do you have a history of substance or alcohol abuse?
Yes
No
In the past
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