If you decide to apply for this study, you will need to fill the following form.
A referral letter from a primary licensed healthcare provider is also necessary in order to submit the online application to the UDN.
This referral letter must include:
- Pertinent medical problems and prior diagnoses;
- Medical records of physical examinations, hospitalizations, pertinent office visits, specialist consultations;
- Laboratory test results;
- Imaging on disks;
- Biopsy slides when available;
- Video of speech, gait, hand movements when impaire
FORM ON LINE