Gout Studies

If you are interested in participating in the study, please complete the following application.  The Arthritis Treatment Center conducts clinical research studies continually and appreciates your interest in research. 

Please fill out the application form below

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Salutation: Please select a title Mr. Mrs. Ms.
First Name: *
Last Name: *
E-mail: *
Date of Birth:
Street Address:
City:
State:	Zipcode:
Indicate the preferred time for us to call you.
Home Phone:	Click the button to tell us which number you prefer we use first.
Work Phone:
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Are you currently taking DMARD therapy (i.e. methotrexate, Arava, Imuran, etc…)?
5mg 7.5mg 10mg 12.5mg 15mg	17.5mg 20mg 22.5mg 25mg
Are you currently taking Biologic Therapy (i.e. Humira, Enbrel, Remicade, Orencia, etc.)?
Humira Enbrel Simponi Remicade Cimzia Orencia Rituxan Actemra Ocrelizumab Investigational
Have you had any cortisone, hyaluronic injections? Cortisone Hyaluronic Supartz Synvisc
Last injection date:
Location of injection: Knee Shoulder Hip
Notes:
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