Registration
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Account Registration

PatientCrossroads collects health information in a way that protects your privacy and allows you to control access to your information. To register, you must meet one of the following:

  • Have or be at risk to develop a health condition, be age 18 or older and be able to make your own medical decisions
  • Represent a child or dependent who has or is at risk to develop a health condition and for whom you can legally make medical decisions.

Questions about privacy?

Account Holder

The person entering the data
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* This Field is required Information for: Preferred Language : Your preferred language
Information for: Your Relationship to Participant : Please tell us how you are related to the participant.
* This Field is required Information for: Email : Please enter a valid e-mail address. A confirmation email will be sent to this address upon registration.
* This Field is required Information for: Confirm Email : Please confirm your email address by entering it again.
* This Field is required Information for: Username : Please enter a valid username.  No spaces, at least 3 characters and contain 0-9,a-z,A-Z
* This Field is required Information for: Password : Please enter a valid password.  No spaces, at least 8 characters and contain at least 1 lower-case letter, 1 upper-case letter, 1 number, and 1 symbol character
* This Field is required Information for: Verify Password : Please enter a valid password.  No spaces, at least 8 characters and contain at least 1 lower-case letter, 1 upper-case letter, 1 number, and 1 symbol character

Permission


By clicking the box, you agree to participate. If you change your mind and wish to stop participating, you are free to do so without having to provide any explanation. You also agree to the terms and conditions and privacy policy.

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About the Registry


Who will have access to my information?

Only trained registry managers will have access to your contact information. Your identity, such as your name or email address, is NEVER shared unless you request that it be shared. You can set your sharing preferences for each survey that you decide to complete.

How will my identity be protected?

All personal identifiers, such as your name or email address, are removed before your information is shared unless you ask us to disclose your contact information.

Who should I contact if I have any questions?

If you have questions that are not answered on this page, please explore the Frequently Asked Questions or Contact Us.

 

Please enter the code below in all lowercase letters to confirm your registration. Phones and tablets may default the first letter to uppercase, only lowercase letters are accepted.

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