Patient Registration Form

The ALS Society of BC is charitable non-government funded organization dedicated to providing direct support to ALS and PLS patients, along with their families and caregivers, to ensure the best quality of life possible while living with ALS or PLS. Through assisting research, we are committed to find the cause of, and cure for Amyotrophic Lateral Sclerosis (ALS). Through fundraising and donations, the society is able to provide services and programs at no cost to ALS patients and their families.

Please fill out the online or PDF registration form. The ALS Society of BC ensures the confidentiality of your information. ALS or PLS patients are not required to pay any registration fees.

Registration Forms:

If you have any questions regarding filling out the registration form, please contact our Patient Services Manager, Alexandra Guerrero, by phone: 604-278-2257 ext. 226 or email.