CADASIL

 

CADASIL TOGETHER WE HAVE HOPE REGISTRY

All information provided to us is kept strictly confidential! 

Please if you have more than one family member with CADASIL, complete each form separate.  This will assist us and the medical community.

Thank you
 

Your name:
E-mail:
Do you have CADASIL?Yes
No
Location (city, country)
What test was done to confirm you diagnosis
Ethnicity/Race
Age at Diagnosed:
Female/MaleFemale
Male
Present Age
Symptoms
Address
Your Phone Number
Any other information you would like to share or suggest about CADASIL for the website:
If your doctors knows about CADASIL, please provide doctor's name, phone number or address: