REGISTER NOW

We invite you to join the Alpha-1 Canadian Registry! Participation in the registry is entirely voluntary, and you may withdrawal for any reason at any time. All information will be held in strict confidence. While there is no direct benefit from taking part in the registry, the purpose is to follow Canadians with alpha-1 antitrypsin deficiency to improve our methods of diagnosis, assessment, and management of the disease. We also keep you up to date on research advances, treatment options, events, and opportunities to participate in clinical trials.

To join the registry, please print the PDFs below, fill them out manually and mail/fax to: 

Toronto Western Hospital - 399 Bathurst Street. 7 East, Rm 445. Toronto, ON M5T 2S8 / Fax: 416-603-5020

You may need the help of your physician to fill out the Baseline Information Questionnaire.

 

FORMS   

  1.  Information and Consent Form 
  2.  Release of Medical Information Form 
  3.  Baseline Information Questionnaire
  4.  St.George's Respiratory Questionnaire