Paget's Disease of Bone New England Registry

There are no exclusions for this registry. The information you provide will be used to ascertain prevalence of Paget's Disease of Bone.

No patient may be enrolled in the registry without his/her express consent.

All information you provide is confidential, handled as a medical record would be.

Please refer patients by completing the form below. A formal note will be mailed to you seeking permission to mail your patient a packet of information about The Paget Registry. Please sign and mail it back to the New England Registry for Paget's Disease of Bone; include the patient(s) name and address and we will send out the registry enrollment packet. Or simply give the patient the enrollment packet in your office.

Any questions, please do not hesitate to call, write, or email.

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Physician Information
Physician's Name:*
Address:*
City or Town:*
State:*
Zip:*
Phone:*	- -
Fax:	- -
Email:
Contact person in the office:
	Please check here if we may include your name in a list of participating physicians on our website.

The New England Registry for Paget's Disease of Bone, 55 Fruit Street, Bulfinch 165, Boston, MA 02114