Register for KLIK UK

Southampton General Hospital

BRAIN TUMOURS

PROMOTE SUHT

Register for KLIK UK

Department PROMOTE SUHT
Hospital Southampton General Hospital
First two letters of your child's first name and the first two letters of his/her last name (without spaces).
Your account

What is your relationship to the child?

What is your date of birth?

dd-mm-yyyy

Your e-mail address:

Does anyone else take care of the child?

What is his/her relationship to the child?

What is his/her date of birth?

dd-mm-yyyy

If you want to create a separate account (with a separate password) for this person please fill in his/her e-mail address. When this field is left blank you will share a single account.

Child's e-mail address
If your child is 8 years or older and has their own e-mail address, please enter this address here. Both you and your child will be sent the password and notified when it is time to complete the questionnaires.

You can leave this field empty if your child does not have an e-mail address.
Date of birth of the child dd-mm-yyyy
Gender
Terms
Is your child 8 years or older and able to complete questionnaires by him/herself?
The reason for this is:



Comments:
Date of next appointment with the healthcare professional:
dd-mm-yyyy
Doctor