Registering with ALS Quebec is important and will allow you to benefit from all of our services.

You will not only be better equipped to deal with the disease, but you will also have access to important information on ALS.

By registering, you will also be helping ALS Quebec to better understand individuals’ needs within our community. When someone diagnosed with ALS registers, it helps us understand how the disease impacts the lives of Quebecers and the Canadian population.

If you would rather submit your registration form by mail or fax, download the form here.

Registration - Person with ALS

I would like to receive:

Doctor who diagnosed ALS

Treating Neurologist

Family doctor


Readaptation Centre

Other Health Institution

Principal Caregiver

Secondary Caregiver

Children of the afflicted person

Other Information


If form is filled by other than afflicted person

2 + 1 = ?