ALK Register

ALK Positive Lung Cancer (UK)

Thank you for asking to be added to the ALK Register which is only for patients with ALK-positive lung cancer, living in the UK and Ireland, and a close family member or friend.

Could you please complete this questionnaire. We will not share any personal identifiable information with any other organisation or person.

You can have your details removed from the register by using Contact Us on our website at www.alkpositive.org.uk.

Question Title

* 1. Name

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* 2. email

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* 3. Telephone No.

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* 4. Address

Address

Address 2

City/Town

Post Code

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* 5. I am

the patient

family member/friend