Welcome to the US HAE Association

...… providing wide-ranging patient services and pioneering new HAE research


Please fill out the following form so that we can provide you and your family with the latest information on new and exciting HAE treatments. If you are interested in participating in any of the HAE clinical trials, please be sure to indicate that on the form. We value your privacy, we will never disclose personally identifiable information to an outside party.
** Please Complete All Fields - Your Data Is Strictly Confidential
Firstname:     Lastname:
Angioedema Type:
Address:
City:      State:   Zipcode:
Country:
Email:
Phone:
Date of birth:      
Insurance company:
 Other:
Preferred Hospital for Emergencies:
Physician who treats you for HAE:
Physician's address:    Physician's phone:
Physician's specialty:    
Would you say your doctor is knowledgable about HAE?:
Attacks per year:
Are you interested in clinical
trial participation?:		  Yes, I'm interested    No, I'm not interested
# of family members With HAE (not including myself):
Comments/ Questions:
 

              



The US Hereditary Angioedema Assoc., Seven Waterfront Plaza, 500 Ala Moana Blvd., Suite 400, Honolulu, HI 96813, (866) 798-5598
The US HAEA's 2010 corporate sponsors
ViroPharma CSL Behring Dyax Shire Pharming