Arthritis Registry Sign-up Form The Arthritis Society, Newfoundland and Labrador Division is your one-stop source for arthritis information. Our goal is to empower people to gain knowledge and control of their disease. To join The Arthritis Registry and help us know more about your needs, please complete the form below. We will send you information tailored to your request including regular updates on advances in arthritis management. Email:      First Name:      Last Name:       Title:      Select a title Mr. Mrs. Ms. Dr. Other   Street Address:      Town/City:       Province:     NEWFOUNDLAND AND LABRADOR Postal Code:      Phone:        MaleFemale Date of Birth Have you been diagnosed with arthritis by a doctor?    Yes      If yes, in what year?       No      If no, what is your interest in joining The Arthritis Registry?      I think I may have arthritis      A family member/friend has arthritis      I think I might get arthritis      I am a health professional           If a "health professional", please state your speciality:            If yes, who were you diagnosed by?    Family Physician Rheumatologist   Other (please indicate) What type(s) of arthritis do you have? (Please check all that apply)    osteoarthritis rheumatoid arthritis fibromyalgia ankylosing spondylitis gout/pseudogout scleroderma lupus psoriatic arthritis juvenile arthritis reactive arthritis polymyalgia rheumatica sjogren's syndrome other (please indicate) Have you visited any of the following health professionals because of your arthritis?    Rheumatologist Orthopedic Surgeon Occupational Therapist Physical Therapist Other    If other, please specify:     Are you on a wait list to see a rheumatologist?    NoYesIf yes, since what date? I would like the following information included in my Registry package:    my type of arthritis volunteer opportunities   self-management programs becoming an advocate   exercise Jingle Bell Walk and Run   books & videos Joints in Motion Training Team   booking a speaker making a donation Other general comments:   The information you have requested from The Arthritis Society will be sent to you at our earliest opportunity. Thank you for joining our Arthritis Registry. The Arthritis Society respects your privacy. We do not sell, trade or otherwise share our mailing lists. The information you provide us with will be used for the purpose of managing our programs and services and distributing related information. Thank you for your time. Please click "send" only once.