Patient Inquiry

Section A

Who is this request for?

This helps us route your inquiry to the right team and provide the most relevant information.

I am the patient

Inquiring on my own behalf

I am a caregiver or family member

Representing someone with a condition

I am a healthcare provider

Physician, nurse, or medical professional

Other

Please specify below

Section B

Contact Information

We use this only to respond to your inquiry. Your information is never shared or sold.

First Name *

Last Name *

Email Address *

Phone Number

Preferred Contact Method

Phone

Section C

Location

Location helps us understand regional access programs and applicable trial sites.

Country *

ZIP / Postal Code

Section B · Medical Affairs

Professional Contact

We use this to connect you with our Medical Affairs team. Your information is held in confidence.

First Name *

Last Name *

Email Address *

Phone Number

Professional Role

Medical Specialty

Preferred Contact Method

Phone

Section C · Medical Affairs

Location & Affiliation

Helps us route you to the appropriate regional Medical Affairs contact.

Institution / Hospital / Practice *

Country *

We ask only for high-level medical context — enough to direct your inquiry appropriately. Please do not include detailed lab values, treatment history, or insurance information at this stage.

Section D

Medical Context

High-level information helps us route your inquiry and identify relevant programs.

Condition / Diagnosis *

Stage or Severity

Has the patient been formally diagnosed by a physician? *

Yes, formally diagnosed

No, not yet

Not sure / seeking information

Medical Affairs

Nature of Inquiry

Select the type of engagement you're requesting. You can choose more than one.

Medical Information Request

Safety, efficacy, or clinical/scientific information about our investigational programs.

MSL Engagement

Request a scientific exchange meeting with our Medical Science Liaison team.

Expanded Access / Compassionate Use

Inquiry on behalf of a specific patient outside of a clinical trial setting.

Research & Publications

Data requests, poster presentations, or scientific publication collaborations.

Additional context or specific question

Program of interest

Section E

What are you looking for?

Select all that apply. You can choose more than one.

Clinical Trial Eligibility

Learn about FALCON-HD or other investigational trials you may qualify for.

Patient Services & Access

Current expanded access, compassionate use, or future availability of our programs.

Medical Affairs

Scientific or clinical information for healthcare providers, caregivers, or informed patients.

Additional details or questions

Section F

Treating Physician

Optional — but providing your physician's information allows us to share relevant resources directly with your care team.

All fields in this section are optional. Providing a physician's information helps us coordinate care and share relevant information with your medical team.

Physician Name

Institution / Hospital

City / Country

Section G

Consent & Communication

Please review and confirm the statements below before submitting your inquiry.

All fields marked * are required.

Step 1 of 4

Important Notice: Skyhawk Therapeutics® investigational therapies have not been approved by the FDA or any other regulatory authority. Submitting this form does not constitute enrollment in a clinical trial or guarantee access to any investigational medicine. Information collected is used solely to respond to patient and caregiver inquiries. For medical emergencies, contact your physician or call emergency services.

We're here to
help guide you
to what's possible.