First Name *

Last Name *

Phone *

Email *

Do you have a diagnosis of Rheumatoid arthritis (RA) for more than 3 months?

You are currently enrolling in a study for Rheumatoid arthritis (RA). Are you interested in any other studies at the Altoona Center for Clinical Research? *

Date of birth

What is your current weight? *

What is your current height? *

Have you ever been a patient of Altoona Arthritis & Osteoporosis Center and/or Altoona Center for Clinical Research? *

Do you have a history of cancer? *

How did you hear about us? *

Is there any other information you would like to provide us for your request for enrollment?

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