Digital registry in adult-onset leukoencephalopathy with
axonal spheroids and pigmented glia (ALSP)

Pre-registration survey

Please complete this short application form to indicate your interest in participating in the adultonset leukoencephalopathy with axonal spheroids and pigmented glia (ALSP) patient registry. If the registry becomes available in your country, a member of the Vitaccess team will contact you via email with information on how to sign up.

    What country do you live in?

    What state do you live in?

    I am 18 years or older:
    You must be 18 or over to participate in the study.


    Please select one of the following that best applies to you:

    This survey is collecting your responses to the above questions, which may contain sensitive information. Do you consent to our collection and processing of this health information as described in our privacy policy?
    If you click no, you will not be able to register you interest in taking part in this study.

    Do you consent to being contacted by Vitaccess about the ALSP patient registry?

    We might also like to contact you to see whether you are interested in taking part in any other related research.
    Do you agree to being contacted by Vitaccess about other related research?

    We might also like to contact you to see whether you are interested in receiving information about relevant patient associations.
    Do you agree to being contacted by Vitaccess about receiving information about relevant patient associations?



    If you have any questions about the registry, you can contact us at alsp@vitaccess.com.
    Your privacy and rights are incredibly important to us. Please read our Privacy Policy for more information.

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