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