Please fill in all the fields.
These personal data allow us to include you in our patient database, to identify you and to communicate with you.
The personal data relating to your health or that of the ALS patient for whom the registration is done gives us insight into the nature and condition of ALS. The knowledge of this personal data ensures that we can adequately inform and guide you in the framework of the offer of our services.
Copyright © 2020, ALS League Belgium