All information submitted through this questionnaire is confidential, submitted using SSL encryption, and will be used only for a preliminary determination by Intervene Immune, Inc. of whether or not you are qualified to enter a study or treatment program. Prior to enrollment, you must complete a blood test and also a formal informed consent process including a review of the protocol in consultation with a physician and study investigator.
Please keep in mind that all questions are not necessarily indicative of eligibility. We are actively trying to provide options for treatment to as many people as possible. Accurate and comprehensive answers will help our team craft a more responsible and effective treatment regimen that is customized for you.