Registration

Please complete this form and click on the “Continue” button to start the registration. Please see the patient information page for information on how the data you enter will be used. Children (under 16 years) must be registered by their parent or guardian. This study is only open to people who live in the UK.

If you have already registered and would like to update your data or add another patient, you don't have to fill in this form again. Just go to the login page and login with the e-mail address and password you previously registered with.

Personal data

Please enter your own details here, even if you are not the patient yourself. If you are registering a child as a patient, you will be able to enter his or her details in a later step. Please note that you must be the patient’s parent or guardian to enter a patient other than yourself.

First name(s)

Surname

Date of birth as day/month/year, e.g. 19/03/1967

Sex

male

female

User account

With your e-mail address and the password you choose here, you can log in at any time to view or edit your data. In order to protect your personal data against unauthorised access, please choose a password which is hard to guess and write it down in a safe place. Note that the password is case-sensitive. Your password must be at least 6 characters long.

E-mail address e.g. joe_bloggs@example.com

Password

Repeat password

I consent to the storage of the information above as well as my contact data as described in the Data Protection Statement and agree to be contacted about my registration if needed.