Patient Login - Castleman Disease Collaborative Network

Title

First Name*

Last Name*

Email*

Phone

Date of Birth*

Address 1:

Address 2:

City

State/Province*

Zip Code*

Country*

What is your relationship to Castleman Disease?*

If you are a loved one and not the patient, please provide the patient’s information below. If you are the patient, please skip to the Patient Diagnosis section.

Patient’s First Name:

Patient’s Last Name:

Patient’s Date of Birth:

Patient’s City:

Patients State/Province:

Patient’s Country:

Patient’s Postal Code:

Is the patient deceased?:

Patient’s Primary Diagnosis*

If diagnosed with multicentric Castleman disease, please select your subtype, if known. If diagnosed with unicentric Castleman disease (UCD), please select “N/A”

Patient’s Additional Subtype diagnosis*

Patient’s Date of Diagnosis*

Patient’s Age at Diagnosis*

Does the patient have any of the following symptoms?*

If diagnosed with multicentric Castleman disease, please select your subtype, if known. If diagnosed with unicentric Castleman disease (UCD), please select “N/A”

Is the patient currently hospitalized for their Castleman disease?*

Additional Diagnoses/Additional Notes:

The CDCN values your privacy policy and will not share or sell your information with anyone else. By clicking Submit, you are voluntarily submitting your contact information and the above information.

Become a member of the CDCN Network

Become a Member of the CDCN Network:

Patient Diagnosis*