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ALS Registry

A few details will help us find the study options that fit you best.

We will only use this information to help match you (or your loved one) with study options.
Your data will be kept secure, and will never be sold to external parties. 
3. Are you an ALS patient or caregiver?
This question requires a valid email address.
If you are filling out this form on behalf of someone else, please be sure to answer the following questions based on their health history.
5. How long ago were you diagnosed with ALS? *This question is required.
6. How old are you? 
7. Do you have familial (inherited) or sporadic (no family history) ALS?
8. What city do you live in? 
ALS studies take place in clinics and hospitals across the United States and throughout the world. A single trial may take place in one or two places, or at hundreds of different sites. Knowing this will help order the study options based on which are closest to you. 
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