• SRNA Registry

  • If you or a family member are diagnosed with a rare neuroimmune disorder, we recommend that you become a member of SRNA before filling out this form. Membership is completely free.

    After you fill out this form, you will receive an email with a link to the survey within 5 business days.

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  • I am a...*
  • I am...*
  • How old is the person you are filling this out for?*
  • Are they able to provide assent to participate in the registry?*
  • Should be Empty: