Welcome to the Vertex VX22-548-104 BUN Referral Management Portal for Circuit Clinical. Use this portal to record patient referrals and refer eligible patients to the appropriate site

Click here to record the end status of a referral that DOES NOT qualify for the trial.

Click here to record a qualified patient referral and refer them to the appropriate site.

Eligible

Select enrolling site from the drop down.

Name

Telephone number

Email address

Please choose a site

I acknowledge that I am at least 18 years old and I consent to being contacted by the study site selected about taking part in this study, and I consent to my data being processed by Longboat as outlined in their Privacy Policy.

Thank you

Thank you. Your information has been sent.

OK

Error

There has been an error submitting your information. Please resubmit the form.

OK

Ineligible

Choose the most appropriate status from the drop-down:

I acknowledge that I am at least 18 years old and I consent to being contacted by the study site selected about taking part in this study, and I consent to my data being processed by Longboat as outlined in their Privacy Policy.

Thank you

Thank you. Your information has been sent.

OK

Error

There has been an error submitting your information. Please resubmit the form.

OK

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