EmailMeForm
Thames Cancer Registry Information Request Form
Please complete this form with details of your information request and how we can contact you, and then click ‘submit’ at the bottom of the page. You will be sent an email confirming that we have received your request.
We advise that you DO NOT include any patient identifiable data on the form as this is not transmitted through a secure network.
We will contact you within 20 working days of receipt of your request, or before then if we need to clarify any details.
If you have any questions regarding your request or completing this form please call us on 020 7378 7688 or email tcrinformation@kcl.ac.uk.
YOUR PERSONAL DETAILS
Name
*
Job title
*
Organisation
*
Tel. no
Email
*
INFORMATION REQUIRED
Cancer type(s) (ICD-10)
*
Area of residence
*
Period of diagnosis/death
*
Sex
*
males
females
persons
Type of analysis
*
e.g. incidence counts, age standardised rates etc
Purpose/objective
*
e.g. reasons for required data/project details
Any other details
any further required specification
Date required by (DD/MM/YYYY)
*
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