To join our database and to receive a $5 gift card if you qualify, please complete the form below. Currently we are looking for patients and caregivers with many different rare conditions. Please fill out the sign-up form below and we’ll let you know if you qualify. If you are the caregiver of more than one patient, or are both a patient and caregiver, please fill out a separate entry for each and you will receive multiple gift cards.
Please be aware that each entry is checked individually. Please include your correct personal phone number as we will call you to verify your information. It may take several days before you receive your gift card if you qualify. Read more about how we use your information.
At this time we are accepting patients and caregivers across all diseases. However, that does not guarantee we will have surveys for you. If there are not any companies that have treatments available, or there are no companies developing treatments, then there would be no sponsors for surveys. But we are always looking for sponsors for all disease categories!
Only one caregiver per household, please! That is because our survey sponsors won’t allow more than one response from caregivers in the same household. If you have more than one caregiver, you can decide which of you can do each survey.
Please note that at this time we are only accepting entries from Canada. If you live in the United States and would like to sign up, please click here. If you have already signed up on the US site, you will not receive a gift card for signing up in Canada.