Patient Registration Form
The ALS Society of BC is charitable non-government funded organization dedicated to providing direct support to ALS patients, along with their families and caregivers, to ensure the best quality of life possible while living with ALS. 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 provide us with the following information, which will be treated in strict confidence. There is no registration fee, for ALS Patients of the ALS Society of BC.

If there are any questions regarding filling out the registration form, please contact Patient Services at 1-800-708-3228 Ext. 226 or 228 or email

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