Register for a 'This Is Me' Rare Patient Passport

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

Thank you for your interest in applying for a 'This is Me' passport via Cambridge Rare Disease Network [CamRARE]. You can apply as an individual, a caregiver, a patient organisation or a healthcare setting.

Please complete this form with some brief details and contact information and we will send you a passport template and guidelines for completion via email.

Many thanks!

The CamRARE Team

Email *

Your full name *

Mobile number *

Which country are you located in? *

Which city are you located in?

Is this passport for you or for a child? *

For me

Someone I care for (child)

Someone I care for (adult)

Use by a patient organisation for their community

Use by a healthcare setting for their patients

Healthcare professional

Other:

Required

If you responded 'patient grp', 'healthcare setting' or 'other' to the question above, please provide details of your organisation and how you'd like to get involved.

If you are applying for a branded passport from a specific patient group, please select which patient group passport you would like us to send you.

Childhood Tumour Trust

FOP Friends

NCBRS Worldwide Foundation

SMS Foundation UK

The Children's Hyperinsulinism Charity

VML ASSO

Wolfram Syndrome UK

Clear selection

Would you like to be added to our mailing list to receive updates and new versions of our passport? *

Yes, sign me up in line with GDPR

No thank you

How did you find out about the passport?

On the CamRARE website

Through social media

On LinkedIn

Word of mouth

Through my patient organisation

Other:

While we're here..

Have you heard about the newly formed Rare Disease Research Network? It's a partnership project between CamRARE and the Patient Led Research Hub, funded by the National Institute for Health and Social Care Research (NIHR) and sponsored by Cambridge University Hospitals NHS Foundation Trust. There is a temporary landing page with background info here www.rd-rn.org

The project aims to support the rare disease community in building an online network of partnerships and resources to facilitate new patient-centred research opportunities. It is being co-produced by members of the rare community, with wider engagement from research and industry.

This Rare Disease Research Network online platform will launch in Nov 2024 for patients and patient groups to share their research ideas and priorities and find research partners.

Would you like to receive more information about this and an invitation to join prior to the launch?

Yes

Submit

Clear form

Never submit passwords through Google Forms.

This form was created inside of Cambridge Rare Disease Network. Report Abuse

Forms