ASTHMA STUDY FORM

Please complete this form to learn about this remote asthma study. Study participants will be provided with an FDA-approved asthma rescue inhaler, AIRSUPRA™, for 12 months. If you are eligible, you will be given a voucher to pick up AIRSUPRA, at no charge to you, from your preferred pharmacy. You must be 18 years of age or older.

First Name *

Email *

Cell Phone *

Have you had at least one asthma exacerbation that resulted in taking prednisone, a steroid shot, urgent care visit, or hospitalization within the last 12 months? *

Have you had at least one filled prescription for albuterol or levalbuterol in the last 12 months? *

This study is done remotely. After you submit your information, a member of our team will reach out to you to answer any questions you have and to make sure this study is right for you.

You agree that your information will be shared with Clinical Hero and Tufts Medical Center, who may contact you via phone, text, and email to inform you of any available research studies. Clinical Hero will NOT sell your information to any third-party marketing firm. You agree to the terms of Clinical Hero's privacy policy and its terms and conditions. If you are contacted, Tufts Medical Center will identify themselves. You can opt-out at any time.

I agree *

Check here to agree