IFCR Partner Information

Country*
State / Province*
Address*
City*
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*
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Email*
Confirm Email*
Phone

Association with CDKL5

Association with CDKL5*
  • Parent
  • Sibling
  • Relative
  • Therapist
  • Medical Professional
  • Caregiver
  • Teacher
  • Other

Please tell us more about your loved one affected with CDKL5, providing this information is confidential and will only be used with your permission to do so. 

Child Name
Child Date of Birth
Diagnosis/Mutation (p. or c.)
Are you interested in volunteering with IFCR?
  • Yes
  • No

We realize CDKL5 can be very intimidating and heartbreaking news to receive. We know that this new diagnosis opens up another world of uncertainty, questions and fears. We are hear to guide you and available to follow up with you to assist in providing diagnosis specific information.

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