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Clinical Trial Interest Form
Please fill out the form below.
Small Cell Lung Cancer, Sarcoma, and Malignant Melanoma | Y-mAbs 1001 Trial
First Name
Middle Name
Last Name
Date Of Birth (ex 01-DEC-1963)
Email
Mobile Phone
Have you been diagnosed with any of the following?
Small cell lung cancer
Sarcomas such as Ewing sarcoma or osteosarcoma
Melanoma
Have you been diagnosed with any of the following conditions?
Any autoimmune disease or immunodeficiencies
Heart disease
Any other active malignancy (cancer) in the past 3 years
Any other serious medical problem not related to cancer
N/A
Please give any additional details about your disease or condition, including any prior treatments you have undergone
Submit