Family Member Registration Personal Details Email* First Name* Last Name* User Name* Password* Confirm Password* Are you available to Volunteer?* Yes No Are you the Legal Guardian on the Patient Yes No Contact Details Street Address City or Town Province* Patient Details Patient First Name Patient Last Name Birth Year* Is Patient followed by an Ophthalmologist?* Yes No If Yes, Who is the Ophthalmologist? Has patient had genetic counselling?* Yes No If you had Genetic counselling and know your specific mutation, please enter it.
