MPN Register Patient - Sanius Sign Up

Capturing a clearer picture of your health and MPN.

Complete the sections below to register as a Sanius member

First Name
Last Name
Email Address
Phone Number
Are you currently on any of the following prescribed medicine for your condition? (Select all that apply) RuxolitinibAspirinClopidogrelHydroxycarbamideInterferonThalidomideAnagrelideCytarabineFedratinib
Are you a patient from the Guys and St. Thomas’s NHS Foundation Trust?

I AGREE THE SANIUS HEALTH PLATFORM TERMS OF USE Confirm
I AGREE TO THE TERMS OF THE PRIVACY POLICY Confirm
I understand that the information provided in this form will be used to complete a Subject Access Request Application to obtain GP and hospital data Confirm

By submitting your application, you will be registered as a patient at Sanius and our patient relationship manager will be in touch shortly.

Capturing a clearer picture of your health and MPN.

Complete the sections below to register as a Sanius member

First Name
Last Name
Email Address
Phone Number
Are you currently on any of the following prescribed medicine for your condition? (Select all that apply) RuxolitinibAspirinClopidogrelHydroxycarbamideInterferonThalidomideAnagrelideCytarabineFedratinib
Are you a patient from the Guys and St. Thomas’s NHS Foundation Trust?

I AGREE THE SANIUS HEALTH PLATFORM TERMS OF USE Confirm
I AGREE TO THE TERMS OF THE PRIVACY POLICY Confirm
I understand that the information provided in this form will be used to complete a Subject Access Request Application to obtain GP and hospital data Confirm