Explore Clinical Trials - Test

[EN] Explore Clinical Trials (Conversational) (#107)

As you begin this journey, we are here to help you find cancer clinical trial options personalized just for your cancer care.

What is your cancer type?

What is your gender?

Female

Male

Your Birthday

Month

Day

Year

What is your legal name?

What is your email address?

What is your phone number?

What is your zipcode / postcode?

Cancer Center Where You Get Treated

Your Treating Physician

Medical Records Collection Consent

(HIPAA/GDPR Authorization)

- Access quality care. Your consent is the first step in clinical matching.
- We use your data solely to assess your eligibility for clinical trials. Your data will remain private and secure with us.
- Your preferences can be updated at any point during the process.
- A dedicated patient relations coordinator will call you to discuss details further.

By filling out this form, you're consenting only to release your medical records. You're not agreeeing to participate in clinical trials yet.

By providing your information you agree to terms and conditions, privacy policy and HIPAA notice.