Patient Registry

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NKCF Patient Registry Form

To sign up for our KC Registry, please fill out the form below.

Sign me up for the KC Patient Registry

Name:*

E-mail:*

Street:*

City/State:*

Zip Code:*

Country:*

I have Keratoconus in

I have other family members who have Keratoconus

I was first diagnosed with Keratoconus in the year:
At age:

I wear:

I have had a corneal transplant

Gender:

Year of Birth:

* = required fields

Ethnicity:

Welcome to the NKCF!

Thank you for signing up for the KC Registry.

mailbox2 You will also receive the NKCF Newsletter three times a year and the Discovery Fund for Eye Research (our parent organization) Newsletter twice a year. Occasionally we send announcements about special KC events in your area. But we will not to pester you, nor will anyone else. We never share our list.

Catherine Warren
Executive Director

Please consider a modest donation to help defer our costs. You can choose to donate using:

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