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RARE DISEASE DATA REGISTER OF INDIA
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Enrolment Form
Your Name
Age
Gender
Select Option
Male
Female
Name of the rare disease
Select Option
Batten Disease
Duchenne muscular dystrophy (DMD)
CANDLE Syndrome
Childhood Interstitial Lung Disease
Cystic Fibrosis
Ehlers-Danlos syndromes
Ellis Van Creveld syndrome
Gaucher disease (Types 1, 2 and 3)
Haemophilia
Hemangiomas
Hirschsprung disease
Krabbe Disease
Neuroblastoma
Pompe disease
Sickle-cell Anaemia
Spinal Muscular Atrophy
Thalassemia
Don't Know
Whether genetic testing is done or note
Symptoms observed a what age
Is the person is studying
Yes
No
Education qualification
School Dropout
10th
12th
Bachelors
Masters
PHD
None
Does the person have a job?
Yes
No
Your District
State
Does not know the name of the rare diseases
Yes
No
Is anyone in your family is suffering with rare diseases
Yes
No
Address
Your Phone
Landline
Your Email
Any Social Profile Link
Submit
