Venous Leg Ulcer | Hero Clinical Research

Venous Leg Ulcer (please only submit one inquiry)

Please complete the form as thoroughly as possible to help us find the best trials to support your health needs

First name

Middle Initial

Last name

Preferred Language

English

Spanish

Other

Email

Phone

Address

List your current health conditions or concerns below

This will help us find the best study fit for you.

(You may enter multiple)

Are you taking any medications?

Birthday

Month

Day

Year

Gender At Birth

Male

Female

Do you have a wound/ulcer?

Yes

No

Is the ulcer not healing despite treatment with standard care (dressings, cleaning)?

Yes

No

Does the ulcer NOT expose bone or tendon?

Yes

No

Not Sure

Does the ulcer NOT show signs of infection (no pus, cellulitis, severe redness)?

Yes

No

Not Sure

Has your doctor told you your A1C is less than 12% in the past 3 months?

Yes

No

Not Sure / I Don't Know

Consent to Be Contacted and Use of Health Information

I voluntarily consent to be contacted by Hero Clinical Research regarding participation in current or future clinical research studies. I understand that the information I submit, including any health-related data, may be used to determine my eligibility for research opportunities.

I understand that my information will be kept confidential and handled in compliance with applicable laws, including HIPAA (Health Insurance Portability and Accountability Act), and will not be shared outside the study team without my permission.

Single choice

I Consent