Registration

Please complete this form and click on the “Continue” button to start the registration.

If you have already registered and would like to update your data or add another patient, you don't have to fill in this form again. Just go to the login page and log in with the e-mail address and password you previously registered with.

Type of registration

As a doctor, you can enter further data on any of your patients who have registered here.

I am a patient or the guardian of a patient

I am a doctor or another medical professional

Personal data

Please enter your own details here, even if you are not the patient yourself. If you are registering a child as a patient, you will be able to enter his or her details in a later step. Please note that you must be the patient’s parent, guardian or doctor to enter a patient other than yourself.

First name(s)

Surname

Date of birth as year-month-day, e.g. 1967-03-19

Sex

male

female

User account

With your e-mail address and the password you choose here, you can log in at any time to view or edit your data. In order to protect your personal data against unauthorised access, please choose a password which is hard to guess and write it down in a safe place. Note that the password is case-sensitive. Your password must be at least 6 characters long.

E-mail address e.g. joe_bloggs@example.com

Password

Repeat password