Registration 2017-11-16T12:12:18+00:00

Lymphedema Study Registration

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Are you male or female?
How old are you?
Have you been diagnosed by a healthcare professional with Lymphedema or swelling due to a blockage of your lymph vessels?
Were you diagnosed as having either Primary or Secondary Lymphedema?
Were you born with Lymphedema?
Did cancer or the treatment for cancer cause your Lymphedema?
What type of cancer caused your Lymphedema?
What parts of your body are affected by Lymphedema? (select all that apply)
Do you currently wear compression garments?
Have you undergone surgery to treat your Lymphedema?
Have you undergone complete decongestive therapy (also called lymphatic drainage) to treat your Lymphedema?
May we contact you about participation in an Eiger-sponsored Lymphedema study?
What is the best way to contact you?
First Name
Last Name
Valid Email Address
Country Code
Phone Number with Area Code
Street Address
City
State/Province
Zip/Post Code
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