Thank you for your interest in Joined Bio's blood collection lupus study.
Please fill out the information below to see if you qualify.
Study qualification status
Name
*
First Name
Last Name
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
City and State
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
What is your age?
*
What sex were you assigned at birth?
*
Female
Male
Prefer not to say
Have you been clinically diagnosed with Systemic Lupus Erythematosus (SLE)?s
*
Yes
No
Have you been diagnosed with HIV 1/2, hepatitis B, or hepatitis C?
*
Yes
No
Are you willing to participate in a study requiring an blood collection (about 1.5 ounces) at your home? We will send a trained phlebotomist to you.
*
Yes
No
Are you willing to provide Joined Bio with a copy of your medical records or authorize Joined Bio to retrieve them from your providers? Medical record information is required for this study.
*
Yes, I am willing to get them myself
Yes, I am willing to authorize Joined Bio to obtain them
No
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Medical Conditions
Please list any medical conditions you have or have had in the past.
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Lupus Medications
Are you on any treatments for SLE or any other autoimmune conditions?
*
Yes
No
I don't know
Does your treatment include rituxiamb or belimumab?
*
Yes
No
I don't know
Do you take corticosteroids, hydroxychloroquine or anifrolumab?
*
Yes
No
I don't know
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Lupus Disease Activity
This study requires understanding your lupus disease activity and your SLEDAI score. The SLEDAI (Systemic Lupus Erythematosus Disease Activity Index) is a clinical and laboratory scoring tool used by physicians to measure disease activity in patients with SLE.
In the past 4 weeks, have you had any symptoms related to your lupus disease?
*
Yes
No
I don't know
In the past 4 weeks, have you had a lupus-related doctor's visit (rheumatologist) along with a blood test?
*
Yes
No
In the last 4 weeks, did you have a SLEDAI assessment performed at a medical visit?
*
Yes
No
I don't know
What was your SLEDAI Score?
*
<10
10-20
>20
Are you willing to fill out a separate 10-minute questionnaire to help assess your lupus disease activity? If yes, you will be directed to complete it at the end of this survey.
*
Yes
No
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Please click the submit button to record your responses.
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