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Join a Clinical Study
Complete the form to see if you may qualify for this
research study.
Commit-UC
Commit-UC
First Name
Last Name
Phone/Mobile
Email
Date of Birth
Address
City
State
Country
Select Country
Afghanistan
Aland Islands
Albania
Algeria
American Samoa
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Angola
Anguilla
Antarctica
Antigua and Barbuda
Argentina
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Macao S.A.R., China
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Romania
Russia
Rwanda
Réunion
Saint Barthélemy
Saint Helena
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Saint Martin (French part)
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Samoa
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Senegal
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¿Tienes de 18 a 70 años?
Sí
No
¿Tienes un diagnostico de colitis ulcerosa de almenos 3 meses o mas?
Sí
No
¿Tienes colitis ulcersoa activa?
Sí
No
¿Tienes obesidad?
Sí
No
¿Cuanto mides?
Medida
4'11"
5'
5'1"
5'2"
5'3"
5'4"
5'5"
5'6"
5'7"
5'8"
5'9"
5'10"
5'11"
6'
6'1"
6'2"
6'3"
6'4"
6'5"
6'6"
6'7"
6'8"
6'9"
6'10"
6'11"
7'
¿Cuento Pesas?
¿Tienes alguna condición de salud relacionada a la obesidad?
Sí
No
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