The EUF Patient Registry Form
If you are interested in enrolling in the EUF Patient Registry, please complete the brief screening form below and click submit. Please note that this registry is patient-reported.
If you are a healthcare provider and wish to refer your patients, please refer them to this form.
If the participant is over the age of 18, and able to enroll themself, they must complete the form below.
If the participant is over the age of 18, and not cognitively able to enroll, and you are the legally authorized representative, you may submit the form below on their behalf.
If you are a parent of an individual under the age of 18, you may enroll the participant.
After you submit this form: the volunteers at EDSers United will send you a consent form and a questionnaire. You will be asked to provide the contact information of the physician who diagnosed you if you claim to have a diagnosed condition. If you have not been diagnosed yet, please submit that you are undiagnosed. We cannot officially count the participant statistically if they have not received an official diagnosis from a licensed health care professional.
We would like to thank you for taking the initiative to assist the EDSers United Foundation in generating up-to-date statistical information. Your participation brings us one step closer to finding a cure and treatment options.
If you have any questions about the EUF Patient Registry, please contact us at EDSersUnited@edsers.org.
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The EDSers United Foundation (EUF) Patient Registry