English
Français
MyCBDR Registration
lastname
I request to access and input MyCBDR data for the following patient/s
Patient Details
CBDR ID (if known):
Given Name:
*
Family Name:
*
Date of Birth:
*
My Relationship to Patient:
*
Self
Mother
Father
Partner/Spouse
Guardian
Friend
Other
Hemophilia Treatment Centre:
*
AB - Alberta Children's Hospital - Southern Alberta Hemophilia Program
AB - Foothills Medical Centre - Southern Alberta Hemophilia Program
AB - Test Center 2 - Test Center 2
AB - University of Alberta Hospital - Northern Alberta Bleeding Disorders Clinic
BC - British Columbia Children's Hospital - Hemophilia Program
BC - St. Paul's Hospital - Hemophilia Program
MB - Manitoba Health Sciences Centre - Bleeding Disorders Program
NB - RHA-B The Moncton Hospital - Hemophilia Clinic
NB - Saint John Regional Hospital - Inherited Bleeding Disorder Clinic
NL - Eastern Health - Hemophilia Program
NS - IWK Health Centre - Pediatric Bleeding Disorder Clinic
NS - Queen Elizabeth II Health Sciences Centre - Hereditary Bleeding Disorders Program
ON - Children's Hospital of Eastern Ontario - MDU Hematology Clinic
ON - Hamilton-Niagara Regional Hemophilia Treatment Centre - Hamilton Health Sciences Corporation - McMaster Children's Hospital
ON - Holding Center for MyCBDR - National Holding Center for MyCBDR
ON - Hospital for Sick Children - Hematology/Oncology Clinic
ON - Kingston General Hospital - South Eastern Ontario Regional Inherited Bleeding Disorders Program
ON - London Health Sciences Centre - Bleeding Disorders Program
ON - St. Michael's Hospital - Hemophilia Treatment Center - Comprehensive Hemophilia Care Centre
ON - Sudbury Regional Hospital - Sudbury and North-Eastern Ontario Hemophilia Program
ON - The Ottawa Hospital - Ottawa Regional Adult Bleeding Disorders Program
ON - Thunder Bay Regional Health Sciences Centre - Hemophilia Program
Other - Test Server - Offline
QC - CHU Sainte-Justine - Centre d'hémostase
QC - CHUS - Hôpital Fleurimont - Clinique d'hémophilie
QC - Hôpital de l'Enfant-Jésus - Centre de l'hémophilie de l'est du Québec
QC - Montreal Children's Hospital - Service d'hémostase congénitale
SK - Royal University Hospital - Saskatchewan Bleeding Disorders Program
My Details
Email Address:
*
Confirm Email Address:
*
This email address will be used to log in to MyCBDR and for password resets.
Given Name:
*
Family Name:
*
Mobile Phone:
Terms and Conditions
I accept the Terms and Conditions.
*
Click here
to view the Terms and Conditions.
I confirm the details provided are true and correct:
*
Cancel
