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? Mother Father Guardian (male) Guardian (female) Grandmother Grandfather What is your date of birth? dd-mm-yyyy Your e-mail address: Does anyone else take care of the child? Yes No What is his/her relationship to the child? Mother Father Guardian (male) Guardian (female) Grandmother Grandfather 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	I agree with the terms and conditions of KLIK UK
Is your child 8 years or older and able to complete questionnaires by him/herself?	My child is 7 years or younger My child is 8 years or older, and can complete questionnaires on the KLIK website (possibly with some help). My child is 8 years or older, but is not able to complete questionnaires. The reason for this is: learning difficulties, possible explanation: physical limitation, possible explanation: other, please provide details: Comments:
Date of next appointment with the healthcare professional:	I don't know the next appointment with the healthcare professional yet. dd-mm-yyyy
Doctor	Dr Gary Nicolin Dr Georgina Bird-Lieberman Dr Kim Bull Dr Ramya Ramanujachar Dr Sarah Curry Prof Colin Kennedy I don't know who my doctor is yet