The Official Website of the Acid Maltase Deficiency Association

It is difficult to say what is impossible for the dreams of yesterday are the hopes of today and the reality of tomorrow. - Robert H. Goddard

Registry

The AMDA maintains a patient registry to help determine the number of people affected by the disease and to provide the medical and scientific community with access to the patient population for treatment of Acid Maltase Deficiency.

AMDA is not affiliated with any one medical group or organization. Equal access to the patient list for treatment of AMD will be available to the scientific and medical community.

However, no information will be released without prior consent of the patient or the legal guardian of the patient.

Following is the patient registration form. Please fill out the form and click Submit to register:

Patient Information

* Name:
* Gender:
Address:
City:
State:
Zip Code:
Country:
Phone Number:
Fax Number:
Email Address:
Date of Birth: YYYY-MM-DD
Current Age:
Disease Onset:
Age Diagnosed:
Ethnic Backgound (optional): This may be helpful in determining ethnic predilection to the disease
Physician who made diagnosis:
Date of diagnosis: YYYY-MM-DD
Where diagnosed:
City/State/Zip:
Do you have medical insurance (U.S. patients):
Physician Name: Current Primary Care Physician
Physician Phone Number:
Fax Number:
Physician Address:
City/State/Zip:
Country:
Parents/Guardians (for Minors):
Parent/Guardian Address:
City/State/Zip:
Country:
Parent/Guardian Phone Number:
Parent/Guardian Fax Number:
Parent/Guardian Email Address:

Disclaimer: The AMDA does not endorse any of the products, medications, treatments or information reported herein. The website and its contents is intended for informational purposes, only. We strongly advise that you discuss all medications, treatments, and/or products with your physician.

Address: AMDA PO Box 700248
San Antonio, Texas 78270 USA