UPLYFT for Lymphoma

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* 1. If you are interested in potentially receiving monetary compensation for matching with a medical survey please complete the form below.

Name

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Country

Email Address

Phone Number

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* 2. Have you been diagnosed with Lymphoma (Non-hodgkin or Classic Hodgkin)?

Yes

No

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* 3. Are you age 18 or older?

Yes

No

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* 4. Have you completed first-line treatment for lymphoma in the past 3-24 months?

Yes

No