Patient Sign Up

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

Rowling CARE 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
Confirmed voluntary participation
Agreed to data/medical notes for research purposes
Opt in for non-identifiable data for research
Opt in to storage of contact details/future contact for other studies
Opt in for contact in design/implementation of future projects
Agreed to be contacted for focus/consultation group

I don't have a diagnosisI don't know what my diagnosis isMultiple 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