Join the Registry
- Call us toll-free at (888) 925-4302 to request an application, or
- Download an application from one of the links below.
- You will need a copy of Adobe Acrobat to view the forms. If you do not have Acrobat on your computer, you can download it free from Adobe.
- Please select the appropriate link below, as the forms are designed to meet your particular needs. There are different forms for adults and children (under 18 years of age).
- Once you have downloaded the forms, please print and complete them and return by mail using the postage paid label provided.
- Please download and complete ALL of the forms so we are able to process your application as quickly as possible. If you need assistance, please call us at (888) 925-4302.
Help us Recruit
If you are a clinic, physician’s office, or patient support group, please contact us to request multiple packets. Please indicate the quantity of each type of packet needed. We will be happy to ship them to you!