Registration and Consent

Create Account

Please create your account by entering your name below. If you a parent or caregiver, you will record information about the person affected by dystonia on the next page.
Your First Name:
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Your Last Name:
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E-mail:
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Username:
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Password:
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Review the terms below and scroll to the bottom to create your account.

You may create an account If

  • You have a form of dystonia, OR
  • You are related by blood to someone with dystonia

Your participation will involve

  • Creation of an online account
  • Completion of a profile with information about your dystonia, treatment you have had, and how dystonia has affected you and/or your family
  • Occasionally updating your profile as information about you changes

You understand that

  • Creating an account and completing a profile assumes that you have consented to participate in the Global Dystonia Registry
  • Private information about you and your health will be stored in a secure database
  • We will never share your private information with other people
  • We may share the information about your condition with other people in the registry and other doctors and researchers, but we will never give out any personal information, such as your name, phone number, email or other contact information
  • Your participation is voluntary and you may withdraw from the registry at any time
  • We will contact you occasionally to ask that you update your profile and to provide you with information about research opportunities relevant to you
Click here for a more detailed explanation of your consent and participation

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I agree to the terms and conditions
 
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