Alopecia Areata

All Studies

Alopecia Areata

Help researchers learn more about Alopecia Areata.

Active Studies

Alopecia Areata Hidradenitis Suppurativa (HS)

Upcoming Studies

Psoriasis

About the Study

We are enrolling participants in a long-term Alopecia registry study designed to collect information about people living with Alopecia Areata (AA). This registry aims to better understand the condition, its impact, and how current and future treatments affect patients over time.

Condition You may qualify for this study if you have been diagnosed with Alopecia Areata (AA), are 18 years or older, and are willing to share your medical history and attend periodic study visits.

Age 18+ years

Diagnosis

Alopecia Areata

Status Active

Treatment No treatment

What are the benefits of enrolling?

Help researchers learn more about Alopecia Areata and improve future care
Share their experiences to support medical and scientific advancement
Receive compensation for time and participation
Be followed by a dedicated research team experienced in dermatologic studies

If you would like additional information about this study, or to schedule an appointment to see if you qualify, please contact Kristen Machado, our Lead Research Coordinator, by calling 567-998-4906 or emailing [email protected].You may also fill out the Clinical Trial Request form below, and we’ll make sure to reach out to you as soon as possible.

First Name*

M.I.

Last Name*

Date of Birth

Email*

Phone*

City

State

How did you find us?

Clinical Trial of Interest* (Select all that apply):

Alopecia Areata

Hidradenitis Suppurativa (HS)

Psoriasis

Questions/Comments

NOTICE: HIPAA AUTHORIZATION REQUIRED TO USE THIS FORM. SIGNATURE FIELD BELOW.

HIPAA AUTHORIZATION. To the extent information in this form is protected health information under the Health Insurance Portability and Accountability Act, as amended, and its regulations (“HIPAA”), I authorize the use and disclosure of such information in accordance with this HIPAA AUTHORIZATION. I authorize the use and disclosure of all of the information that I have entered into this form (“Information”). I am the individual whose Information is included in this form or I am the personal representative of that individual. The purpose of this disclosure is to allow communication of the Information to a the medical practice from whose website I obtained this form. The Information will be disclosed to Dermatologists Of Central States and/or its information technology contractors (“Recipients”) in order to facilitate communication between me and the medical practice. I understand that I have the right to revoke this Authorization at any time prior to my submission of this form by simply not signing this Authorization, but once I sign this Authorization and submit the form, the Information will be disclosed to Recipients in reliance upon my Authorization. I understand that I am not required to sign this Authorization and that any medical practice making this form available on its website may not condition my treatment on whether I use this form to communicate with the medical practice. This Authorization has no expiration date. I understand that the Information used or disclosed pursuant to this Authorization may be subject to re-disclosure by the Recipients and will no longer be protected by HIPAA. I hereby acknowledge that I may print a copy of this Authorization for my records.
TYPE YOUR FULL NAME BELOW AS SIGNATURE AND AUTHORIZATION*

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