Registration & Questionnaire


Before proceeding to the questionnaire, please enter your personal information below.  This private information is secure and will not be shared.  Create a Login Name and Password so that you can log back in.

An asterisk (*) denotes a required field.



* OHSU Patient ID
If you do not have a patient ID, use 999999.


* First Name



  Middle Name



* Last Name



* Email Address



* Login Name



* Password



* Verify password