Hand in Hand Registration page
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Parent/Carer Firstname
Surname
Address Line1
Address Line2
Address Line3
Address Line4
Postcode
Communications Needs
Name of Child
Date Of Birth
Consultant
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Professor Smith
Dr O'Marcaigh
Dr Capra
Dr Pears
Cormac Owens
Dr Malone
Cancer Type
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Acute Lymphocytic Leukemia
Acute Myeloid Leukaemia
Brain Tumour
Ewings Sarcoma
Fanconi Anaemia
Germ Cell Tumour
Hepatoblastoma
Hepatocellular Carcinoma
Kidney - Clear Cell Sarcoma
Kidney - Wilms Tumour
Langerhans Cell Histiocytosis
Liver Cancer
Lymphoma - Hodgkins
Lymphoma - Non Hodgkins
Myeloma
Neuroblastoma
Osteosarcoma
Pituitary Tumour
Rhabdomyosarcoma
Retinoblastoma
Testicular
Thyroid Cancer
Metastatic Desmoplastic round cell tumour (Soft Tissue Sarcoma)
Date of Diagnosis
Gender
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Male
Female
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Language
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English
Polish
Spanish
Latvian
Lithuanian
Other
Secondary Contact Details. Name & Phone No
How you heard about us?
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A person using Hand in Hand services
Friend
Hospital
Internet search
Poster
Social Media
Mobile
Email
Permission to Process Data
Permission to Receive SMS
Permission to Receive Email
I confirm that these details are correct
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