MND Register for England, Wales and Northern Ireland | Registration

Sign up for the project

Registration to the project involves two steps: consent and basic details check, followed by setting up account information. Please read the information in the patient information sheet before consenting. You can view a PDF of the patient information sheet using this link: link to patient information sheet PDF. If you would like to download a copy of the consent for to keep you can do so using this link: link to consent form PDF

If you have any questions please see the contact section for details of how to get in touch.

Project title: MND Register for England, Wales and Northern Ireland

Consent form (version 2, 11/01/2016)

Please fill in all fields below to sign up.

Your details - step 1

Enter your first name as it appears on official documents

Enter your last name as it appears on official documents

Enter month in full. People younger than 16 can't sign up.

The year you first experienced weakness, speech problems, or breathing difficulties. Please enter the year these symptoms started as told to your doctor

Please enter the full post code of where you live
Please enter whether you were male or female at birth

Please enter the name of the person who provides your medical care.

Please choose the name of the hospital or trust that provides your care. If they are not on the list please leave it as 'Select location' type into the box below