BRAVE II Study

Complete this form to see if you qualify…
Questions with an “*” are required.

Name*
First Last
Email*
Telephone (optional)
Diagnosis
- Systemic lupus erythematosus (SLE)
- Drug related lupus (DRL)
- Cutaneous lupus (discoid, subacute, and acute types)
- Possible/Probable lupus
- Something Else
If you select "Something Else" let us know the diagnosis here...
Name of Physician Making Your Diagnosis
Current Rheumatologist (or last rheumatologist visited)*
Current Medications
Questions / Comments / Requests

About Us

Cincinnati Rheumatic Disease Study Group
10495 Montgomery Road, Suite 26
Cincinnati, OH 45242
(513) 559-2130

Connect With Us

1000 Patients Helped by 18 Rheumatologists Since 1991!

Copyright ©2019 - Cincinnati Rheumatic Disease Study Group. All rights reserved. Internet Presence by Main Street Marketing

About Us

Cincinnati Rheumatic Disease Study Group
10495 Montgomery Road, Suite 26
Cincinnati, OH 45242
(513) 559-2130

Connect With Us

1000 Patients Helped by 18 Rheumatologists Since 1991!

Copyright ©2019 - Cincinnati Rheumatic Disease Study Group. All rights reserved.
Internet Presence by Main Street Marketing