CDKL5 Gene Therapy Clinical Trial Recruitment Program

CDKL5 South Asia Foundation is coordinating the recruitment of patients for a CDKL5 Gene Therapy Clinical Trial Program. Completing this application helps our team evaluate potential eligibility based on the study's inclusion and exclusion criteria. Patients may qualify will be contacted regarding the next steps in the recruitment process.

Gene Therapy Clinical Trial Recruitment Program

Applicant

Parent Details

Patient Details

Patient Name *

Patient Date of Birth *

Location

Clinical Trial Eligibility

Has genetic testing been completed? *

Is the genetic report available? *

Would you like the patient to be considered for participation in the CDKL5 Gene Therapy Clinical Trial Recruitment Program coordinated by CDKL5 South Asia Foundation, subject to meeting the trial eligibility criteria? *

Additional Information

Please share any additional medical information, current therapies, seizure history, or anything else that may help us understand patient current condition.

Your information will be kept strictly confidential and will only be used by CDKL5 South Asia Foundation to communicate, clinical trial opportunities. Registration does not guarantee enrolment into clinical trial.

I understand that this registration expresses my interest only and does not guarantee enrolment into a clinical trial. I consent to CDKL5 South Asia Foundation securely storing my information and contacting me regarding clinical trail opportunities.

Clinical Trial Recruitment Notice

This recruitment program is coordinated by CDKL5 South Asia Foundation to identify potential participants for a CDKL5 Gene Therapy Clinical Trial Program. Information submitted through this application will be reviewed against the study's inclusion and exclusion criteria. Families who appear to meet the eligibility requirements may be contacted regarding the next steps in the recruitment process. Submission of this application does not guarantee selection or enrolment into the clinical trial.