Enrollment Forms
It's simple to enroll a patient in the NDB-Cimzia® Study.
Here's all you have to do.
- Identify a RA patient who has started Cimzia® or a nonbiologic DMARD within the last 6 months---whether or not the patient is still receiving that treatment.
- Explain the study to the patient and obtain a signed informed consent. Make sure the patient completes the brief questionnaire. Give the patient a copy of the consent form.
- Completely fill out the physician form on the other side of this instruction form.
- Fax (316-262-0382) the completed physician form and the signed and completed patient form to us or use the return envelope to mail the forms.
Below are the enrollment forms, which you can print for your office use. If you would like to reorder tablets of the forms please contact us at 1-800-323-5871 ext. 119 or email: rebecca@arthritis-research.org
