Thalamic Glioma Registry

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Enroll in the Registry

Filling out this form starts the process of enrolling someone in the Thalamic Glioma Registry.

Please note that only a patient or patient's spouse (or parent if the patient is a minor), may initiate enrollment. If you are not authorized to to begin the enrollment process yourself, please send the thalamicgliomaregistry.com link to an individual who is. 

Please click SUBMIT above. A representative of the Thalamic Glioma Registry will contact you to gather more information and provide you with instructions.

PRIVACY NOTE: Please do not include any health information about the patient in this form

Weill Cornell Medicine Thalamic Glioma Registry 1300 York Ave., New York New York, NY 10022 Phone: (212) 746-2207