CONTRAST-NP Clinical Research Study - Do you suffer from persistent nasal congestion, sinus pain, and nasal polyps?

Parent's Full Name

Email Address

Phone Number (10-digit US)

City and State

What is your date of birth?

Format: Month/Day/Year (e.g., 01/15/1990)

Are you 18 years or older?

Yes No

Sex assigned at birth

Male Female Intersex

Are you using effective contraception?

Yes No

Have you been diagnosed with Chronic Rhinosinusitis with Nasal Polyps (CRSwNP) by a doctor?

Yes No

Have you experienced ongoing symptoms for at least 8 weeks, such as:

Frequent sinus infections Loss of smell or taste Nasal congestion or stuffiness Post-nasal drip or excess mucus Sinus pain/pressure None of the above

Have you received any of the following treatments for CRSwNP in the past 2 years?

Injectable corticosteroids Nasal polyp surgery Oral corticosteroids None of the above

Do you have asthma that has been stable for at least 3 months?

Yes No, my asthma is unstable I do not have asthma

Are you currently taking or have taken any biologic treatments for CRSwNP, asthma, or other conditions (e.g., omalizumab, dupilumab, mepolizumab, reslizumab, benralizumab) within the past 6 months?

Yes No

Have you undergone any intranasal sinus surgery (excluding polyp removal) within the last 6 months?

Yes No

Do you have any of the following conditions?

Active respiratory infections (e.g., acute sinusitis, upper respiratory infections) Chronic liver disease or cirrhosis Currently pregnant, breastfeeding, or planning to become pregnant during the study period Currently taking systemic immunosuppressants HIV, Hepatitis B, or Hepatitis C Severe asthma with a history of exacerbations in the past year Substance abuse Significant psychological conditions None of the above

By submitting this screener form you consent to CliniContact contacting you to confirm the information you have provided either via phone, text or email.

I consent I do not consent

By submitting this form you consent to CliniContact sharing your information with the researchers to contact you in regards to this study.

I consent I do not consent

Are you willing to participate in a research study that includes study-related medical visits, symptom tracking, and investigational treatment?

Yes No

Contact for future studies?

Yes No

What types of studies would you be interested in?

List comma separated keywords