User Information

User Name

Passwords are required to:

not contain your username
be between 8 and 50 characters long
contain at least 1 number (0 - 9)
contain at least 1 uppercase letter (A - Z)
contain at least 1 lowercase letter (a - z)
contain at least 1 special character \!@#$%*()_+^&}{:;?.

Password

Confirm Password

Email Address

Centre

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Patient Information

First Name

Last Name

Date Of Birth

dd/mm/yyyy

Primary Phone

Secondary Phone

Address

Post Code

Disclaimer

1) I agree to the Terms and Conditions
2) I understand the purpose and nature of the Haemtrack system and give consent for my Local Haemophilia Centre and the National Haemophilia Database (NHD) to hold my treatment data and for the NHD and to analyse it anonymously for research audit purposes.

I agree to both statements above

Haemtrack Registration

User Information

Patient Information

Disclaimer

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