Participation in Microcystic Lymphatic Malformation Clinical Trial Survey
1.
Do you have a diagnosis of Microcystic Lymphatic Malformation or Lymphangioma Circumscriptum?
Yes
No
Unsure
2.
Does your LM lesion leak, weep, ooze, or bleed?
Yes
No
3.
Are you willing to travel for a clinical trial if a site is not close to you? *Costs associated with travel are covered by the study.
Yes
No
Unsure
4.
How old is the person that is interested in participating? *The current age required to participate is 13 years or older but that may change in the future.
5.
Please provide your full name.
6.
Please provide your state.
7.
Please provide your phone number and email address.
8.
Do you give your permission to Minnesota Clinical Study Center to release your name, phone number and email address to participating LM Clinical Trial Coordinators for this study to have direct contact with you?
Yes
No