Psoriasis Research Study at Epiphany Dermatology of Kansas

Got Psoriasis? You may qualify for a research study.

Below is a pre-screening survey to help us determine your qualification in one of our studies. You may stop the survey at anytime. All information provided is confidential.

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* 1. What is your first name?

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* 2. What is your last name?

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* 3. Phone Number:

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* 4. Email:

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* 5. If female, are you currently pregnant or planning a pregnancy or nursing?

Yes

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* 6. How would you describe the appearance of your psoriasis?

Red patches on skin

Inflamed, red lesions covered by silvery white scales

Round red areas on skin

Other

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* 7. On an average day, how much Psoriasis do you have covering your Body Surface Area (your entire body)? (Using your palm to measure, Your palm=1% Body Surface Area)

I have less than 5% Psoriasis

I have less than 10% Psoriasis

I have greater than 10% Psoriasis

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* 8. Which therapies are you currently using for your Psoriasis?

Topical Medications (Over the counter)

Topical Medications (Prescription)

Oral Medications

UV Light Therapy

Biologic Therapy (injectable)

None

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* 9. Have you had a medical diagnosis of psoriasis for at least 6 months?

Yes

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* 10. Have you participated in a research study within the last 6 months?

Yes