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Membership Application - Email Only

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NOTE:  IF YOU WISH TO RECEIVE EMAILS FROM OTHER PATIENTS OR WISH YOUR EMAIL TO BE SHARED WITH OTHER PATIENTS, YOU MUST PROVIDE THE PATIENT INFORMATION BELOW. 
I would like to receive emails from other Cushing’s patients.
I would like the CSRF to provide my email address to patients that contact us.

Age at diagnosis

Patient Birth date

Patient Gender

  
Female Male  
The patient has/had Cushing's due to:

Not yet diagnosed

Pituitary tumor

Ectopic Cushing’s

Cyclic Cushing’s

Adrenocortical Cancer

Diagnosed with Cushing’s, cause not yet known

Adrenal tumor

Bilateral adrenal disease

Medication induced Cushing’s
Has the patient had:
No surgery

Pituitary/transsphenoidal surgery

Unilateral adrenal surgery

Bilateral adrenal surgery

Surgery for an ectopic tumor
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