TUBB4A

Patient Information

To connect with our community, please fill out the form below. Someone will respond as soon as possible to connect you with more information and support.

Patient Name

First Name

Last Name

Birthday

YYYY

Country

NAME OF GENE MUTATION

This information is typically provided on your genetic test report. Example: TUBB4A

CODING DNA OF TUBB4A MUTATION (C.)

This information is typically provided on your genetic test report. Example: c.1228G>A

AMINO ACID/PROTEIN CHANGE OF TUBB4A VARIANT (P.)

This information is typically provided on your genetic test report. Example: p.Glu410Lys

Contact Person

First Name

Last Name

Any additional information you would like to share?

INFORMATION SHARING WITH KINSLOW TUBB4A FOUNDATION AND TRUSTED PARTNERS

By checking this box you agree: (1) that you have permission to share any data submitted about TUBB4A family members through this form, and (2) you voluntarily share the information submitted on this form with Kinslow TUBB4A Foundation and/or our trusted partners for the purpose of advancing TUBB4A research and efforts to discover treatment.

I Agree

TUBB4A FAMILY DIRECTORY AND VARIANT LIST

By checking this box you agree: To voluntarily share the information submitted on this form with the Kinslow TUBB4A Foundation Family Community for the purpose of helping families connect with one another for support.

I Agree

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Kinslow TUBB4A Foundation

a 501(c)(3) nonprofit organization

We are a community dedicated to relentlessly pursuing research, collaboration, and advocacy to ensure that no child's journey is defined by limitations, but rather by possibilities for a healthier and brighter future.

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