Carer/Relative Sign Up

Before completing the online form below, please download and read the following information leaflet:

Rowling CARE Carer Relative Patient Information Leaflet V2.0 Aug 2017

Please see our privacy statement for more details of how we use the information we collection about you.

Confirmed invitation/attendance at ARRNC
Confirmed reading/understanding of information sheet
Agreed to the storage of data by terms
Confirmed voluntary participation
Agreed to data/medical notes for research purposes
I agree to be contacted to assist in the design of research studies and their documentation.
Opt in for contact if there is a need for members of a focus/consultation group

No diagnosisDiagnosis unknownMultiple sclerosis (MS)Motor neurone disease ( MND / ALS )Parkinson's disease (PD)Dementia (any type)Other

relapsing remitting (RRMS)primary progressive (PPMS)secondary progressive (SPMS)Other/I don't know