USA: Temple University Hospital Pre-screening questions 1. Name and Surname *2. Cell phone number *3. Email address *4. What is your year of birth? *Select Year202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119305. When were you diagnosed with pulmonary sarcoidosis? *Select Year202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119306. Are you currently under treatment for pulmonary sarcoidosis? *YesNo7. Do you have any coexisting diseases or pathology? *YesNoI agree to process my personal data (general and special category of personal data) in connection with verification my potential participation in the clinical trial. Please, be informed, that the information about personal data processing is available in the Privacy Notice.Apply Now
