Prescreening Questionnaire: See If You or Your Patient Prequalifies

Please answer this brief questionnaire to see if you or your patient prequalifies for the Rezdiffra™ Pregnancy and Lactation Registry.

The information you provide here will remain private and will only be used to determine if you or your patient might be eligible for this registry.

Do you agree for us to collect your healthcare information to determine your eligibility?

The information you submit, including your Personally Identified Information (PII), will be processed, then stored on a secure server within the European Union. Please visit our Privacy Notice to learn more.

I agree for my responses to this survey to be collected and stored.

This question is required

Are you a patient or a healthcare provider?

Patient

Healthcare Provider

This question is required

Have you (or your patient) taken at least 1 dose of the medication Rezdiffra™ (resmetirom) during the following time periods:

In the 30 days before pregnancy
During pregnancy
During breastfeeding

Yes