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If you are facing amputation due to CLTI, the PROMISE III study may offer you a treatment option.

Please share your name and zip code and we will connect you with a participating center. If you have further questions, please list them in the comments box.

Name*

First Last
Zip Code*
Email*
Phone*
Have you been diagnosed with CLTI/CLI?
- Yes
- No
Explain Further
Do you have a wound on the affected leg?
- Yes
- No
If yes, how long have you had the wound?
If yes, do you regularly see a wound care specialist?
- Yes
- No
On a scale of 0-10 what is your pain level on your affected leg right now?
Comments/Questions

"*" indicates required fields

Name*

First Last

Zip Code

ZIP / Postal Code

Email

Phone

Have you been diagnosed with CLTI/CLI?

Yes

No

Explain Further

Do you have a wound on the affected leg or foot?

Yes

No

If yes, how long have you had the wound?

Years

Please enter a number from 0 to 80.

Months

Please enter a number from 1 to 12.

If yes, do you regularly see a wound care specialist?

Yes

No

On a scale of 0-10 what is your pain level on your affected leg right now?

Comments/Questions

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