CHROMA-CD Crohn's Disease Research Study
CHROMA-CD Crohn's Disease Research Study Now Enrolling
To see if you are eligible, please complete the form below to connect with the research team.
Your privacy is important to us. By completing the following pre-screener you agree to our
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and
Terms of Use
, and agree that we may retain the personal information you provide and share it with personnel involved in the study, or otherwise as described in the
Privacy Policy
, and we or our affiliates may contact you by phone using automated technology or pre-recorded voicemail or other means including but not limited to text messages (standard messaging rates may apply) regarding research studies.
What is your first name?
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What is your last name?
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Please select your gender
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What is your date of birth?
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What is your email address?
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Enter your phone number
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Please enter a valid phone number. E.g. +1 for the US +19541236700
City
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Are you between the ages of 18-75?
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Has a doctor diagnosed you with Crohn’s Disease, which has been present for at least 3 months?
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Yes
No
Has a doctor ever told you that you have ulcerative colitis (UC)?
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Yes
No
Unsure
Have you received prior treatment for Crohn’s Disease? Please select the appropriate response regarding your treatment.
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No
Yes, treatment is working
Yes, but stopped treatment due to it not working “good enough” or stopped working completely
Yes, but stopped treatment due to side effects
Yes, but stopped treatment due to cost
Is your current Crohn’s treatment working?
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Yes
No
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Do you have daily soft or liquid stools?
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Yes
No
Do you have daily abdominal pain?
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Yes
No
Have you had bowel surgery in the past 3 months?
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Yes
No
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Have you had more than 3 bowel surgeries in your lifetime?
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Yes
No
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Do you currently have an ostomy bag (colostomy/ileostomy) or similar device?
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Yes
No
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Have you ever been diagnosed with cancer?
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Yes, skin cancer (basal or squamous cell)
Yes, cervical cancer in situ
Yes, other types of cancer
No
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Which of the following best describes you? Please select one answer.
Why are we asking this question? Clinical research is most effective when it includes a variety of people, which ensures that approved medications work for everyone. Asking this question helps us understand more about those interested in study participation and ensure that people of all backgrounds are represented
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Asian or Pacific Islander
Black or African American
Hispanic or Latino
Native American or Alaskan Native
White or Caucasian
Multiracial or Biracial
A race/ethnicity not listed here
Prefer not to answer
Please select a study location where you would want to attend study visits
Find Study Location