Refer a Friend Program for Netherton Syndrome

Thank you for your interest in our Refer a Friend Program for Netherton Syndrome. To refer an individual with a medical diagnosis of Netherton Syndrome, please complete the form below. Our dedicated recruitment team will promptly reach out to your referred friend or family member, guiding them through the evaluation process. Should they meet the criteria and choose to enroll in the clinical research study, you will be contacted and compensated $1,000 for your referral.

Please note, all information provided will be confidential and securely stored in our study database.

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* 1. Please provide the following contact information:

Your Full Name:

Your Email Address:

Your Referrals Full Name:

Your Referrals Email Address:

Referrals Phone # (Optional if email address is provided):

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* 2. By participating in this program, you are consenting to allow us to share your full name when contacting your referred friend(s) and/or family member(s). Please check the consent box below to confirm your willingness to participate.

Yes, I consent.