Why it's important for you to REGISTER now!
Your registration will populate a registry database which might serve as useful statistics for future lupus researches.
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Lupus Philippines

Lupus Philippines

Registration
* This Field is required Required field | This Field IS visible on profile Field visible on your profile | This Field IS NOT visible on profile Field not visible on profile | Information for: ? : Field description: Move mouse over icon Information: Point mouse to icon

Welcome to Lupus.ph Registration!

First of all, we would like to thank the 173 lupus patients who registered at the old LUISA project patient registry and the 118 lupus patients who registered at the Lupus.ph forum. Upon the implementation of this new registration of the site, unfortunately, we will now archive this list or database of past accounts. This archived list will be kept for future use when necessary. We have retained past forum posts but we recommend past registrants to register again to be able to use the new features of the site. Thank you very much!

Your registration is important. See here why?
Please fill-in the fields below especially the required. Legends are provided for your reference.

* This Field is required This Field IS NOT visible on profile Information for: First Name : Please enter your real first name.
This Field IS NOT visible on profile Information for: Middle Name : Please enter your real middle name.
* This Field is required This Field IS NOT visible on profile Information for: Last Name : Please enter your real last name.
* This Field is required This Field IS visible on profile Information for: Username : Please Enter a valid username. No spaces, at least 3 characters and contain 0-9,a-z,A-Z. If you do not wish to be identified, please provide a username which cannot be identified or related to you.
Your password will be sent to the above e-mail address.
Once you have received your new password you can login in and change it.
* This Field is required This Field IS visible on profile Information for: I am a : Is the registrant a patient, care-giver, or doctor?
* This Field is required This Field IS NOT visible on profile Information for: Email : Please enter a valid e-mail address. A confirmation email will be sent to this address upon registration.
* This Field is required This Field IS NOT visible on profile Information for: Telephone Number : <p>Contact number of the registrant (home, office, or mobile)<br /><br />Example Format:<br />+63(2)5105082&nbsp;&nbsp;&nbsp; = 6325105082<br />+63(920)9876543 = 639209876543<br />0920 987-6543&nbsp;&nbsp;&nbsp; = 09209876543<br /><br />No alpha characters, integer numbers only</p>
* This Field is required This Field IS NOT visible on profile Information for: Mailing Address Street : House Number, Street Name (for some, Lot Number, Phase, Barangay, Zone), District, etc.
* This Field is required This Field IS visible on profile Information for: City : <p>City or Municipality of the Mailing Address<br />Example:</p><ul><li>Pasay City</li><li>City of Manila<br /></li></ul><p>&nbsp;</p>
* This Field is required This Field IS visible on profile Information for: Province : <p>Province or State of the Mailing Address<br />Example:</p><ul><li>Metro Manila</li><li>Pampanga <br /></li></ul>
* This Field is required This Field IS visible on profile Information for: Region : <p>Region of the Mailing Adddress.<br />Example:</p><ul><li>National Capital Region (NCR)</li><li>Region 12 <br /></li></ul>
* This Field is required This Field IS visible on profile Information for: Country : Country of the Mailing Address
* This Field is required This Field IS visible on profile Information for: Gender : Gender and Sex of the Registrant
* This Field is required This Field IS NOT visible on profile Information for: Birthday : Date when registrant was born
This Field IS visible on profile Information for: Occupation : Work designation, position, or current employment status.
This Field IS NOT visible on profile Information for: Educational Attainment : Highest education earned or completed.
* This Field is required This Field IS visible on profile Information for: Marital Status : Marital Status
This Field IS NOT visible on profile Information for: Grand parents' ethnic group or race: : Please indicate lupus patient registrant&#39;s race.<br />This can be used for survey and research purposes.
This Field IS NOT visible on profile Information for: If mixed, please specify approx ratio : Example:<span class="style5"> (75% Filipino, 25% Chinese)</span>
* This Field is required This Field IS NOT visible on profile Information for: Date of Lupus Diagnosis : <p>Date when patient was diagnosed of Lupus by a Doctor.</p><p>If you are not a patient, put the date of lupus diagnosis of the lupus patient you know. Or simply input any date to comply with this required field.</p>
This Field IS NOT visible on profile
This Field IS NOT visible on profile
This Field IS NOT visible on profile Information for: If yes, who in your family has it? : Who has auto-immune related sickness in the family.
* This Field is required This Field IS NOT visible on profile
This Field IS NOT visible on profile Information for: Current Physicians : Current Doctors attending to the Lupus disease.
This Field IS NOT visible on profile Information for: Current hospital/clinic : Current hospital or clinic where you do check-ups or follow-ups. This is usually the hospital of the Lupus doctor or Rheumatologist.
This Field IS NOT visible on profile
This Field IS NOT visible on profile
This Field IS NOT visible on profile
This Field IS NOT visible on profile
This Field IS NOT visible on profile
This Field IS NOT visible on profile
This Field IS NOT visible on profile
 
* This Field is required
 
* This Field is required Required field | This Field IS visible on profile Field visible on your profile | This Field IS NOT visible on profile Field not visible on profile | Information for: ? : Field description: Move mouse over icon Information: Point mouse to icon
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