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At this time, our forms cannot be accepted electronically.   Please print the forms, fill them in manually and mail or fax them to us if you would like to be included in our registry.   

Alpha-1 Data Management Centre
The Toronto Hospital, Western Division
Suite 4-011 Edith Cavell WIng
399 Bathurst Street
Toronto, Ontario  M5T 2S8

or fax to (416) 603-5020
or (416) 603-0348		              Consent Form

Release of Medical Information Form

Annual Follow-Up Form