Registering with ALS Quebec is important and will allow you to benefit from all of our services.

You will not only be better equipped to deal with the disease, but you will also have access to important information on ALS.

By registering, you will also be helping ALS Quebec to better understand individuals’ needs within our community. When someone diagnosed with ALS registers, it helps us understand how the disease impacts the lives of Quebecers and the Canadian population.

If you would rather submit your registration form by mail or fax, download the form here.


Registration - Person with ALS


I would like to receive:


Doctor who diagnosed ALS


Treating Neurologist


Family doctor


CLSC


Readaptation Centre


Other Health Institution


Principal Caregiver


Secondary Caregiver


Children of the afflicted person


Other Information

newspaper
internet
radio
television
Other


If form is filled by other than afflicted person

4 + 4 = ?