CenExel Denver, CO
720-776-0092

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Do you or a loved one have PSP?

Please fill out the below survey to help us determine if you, or your loved one, may qualify for an investigational study aiming to potentially slow disease progression.

Has the patient been diagnosed with Progressive Supranuclear Palsy (PSP)?

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When did you first notice PSP symptoms?

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Can the patient walk 5 steps independently or with a little help (using a cane, walker, or holding onto someone with one hand)?

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Does the patient live in a nursing home?

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Your Name

First Name
Last Name

Relationship to Patient*

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If you are submitting this form on behalf of someone else, you must have that person's consent unless you have a medical power of attorney.

Phone*

Email

E-mail is generally not encrypted. If you do not wish to accept the risks associated with communicating your Personal Information by email, please provide only your phone number.

Address

Address

CenExel RMCR Site Privacy Policy and Terms of Use

Agreement*

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We are committed to keeping your personal information safe and secure. Any information collected will not be sold or shared with third parties.

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