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Clinical Trial Application
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Small Cell Lung Cancer | RYZ101-101
First Name
Middle Name
Last Name
Email
Mobile Phone
How did you find us?
BAMF Employee
External Physician Referral
Social media
Other
Have you been diagnosed with extensive stage small cell lung cancer?
Yes
No
Please describe if you have had any other forms of cancer within the past 3 years
Do you have any of the following conditions?
Any condition requiring treatment with immunosuppressants
Known active or suspected autoimmune disease
Sever infection within the past 4 weeks
Condition requiring antibiotic treatments in the past 2 weeks
Major surgery or organ transplant within the past 4 weeks
N/A
Please describe your current condition, including any treatments you have already undergone.
Submit