Please complete the following information. By completing and submitting this form, you represent you are authorized to share the information below, including the patient's medical information, with LLS.
Upon receipt, an LLS Clinical Trial Nurse Navigator or Information Specialist will reach out to work with you. This service is not a substitute for medical advice. You should discuss what you learn with your treatment team.
For any questions, contact the Information Resource Center at 1-800-955-4572.