Event Registration

Fill out the form below to register for a DBS event.

Email Address*

First Name*

Last Name*

Mobile Phone*

Address

City*

State or Province*

Country/Region*

Zip or Postal Code*

Which condition do you currently have? (Select all that apply)

Essential Tremor (ET)

Epilepsy

Parkinson’s Disease (PD)

Other

Other condition:

Which statement best describes you? (Select one)

I am a l loved one/caregiver of a patient.

I am recently diagnosed patient (Less than 4 years).

I am looking for additional/alternative therapy options beyond medications.

My physician has mentioned Deep Brian Stimulation (DBS) to me before.

I am already implanted with Deep Brain Stimulation (DBS).

Other

Other:

*By registering for this event, I acknowledge that my information will be used for purposes of managing my attendance to this event, per the Privacy Statement provided in the link at the footer of this webpage.

I agree*

A local Medtronic therapy consultant may reach out to you to provide information on DBS programs and events in your area and help with other questions you may have.

I consent to receive marketing and sales communication from Medtronic including product newsletters, news, tips regarding medical devices and accessories, or offers of sale of Medtronic products, therapies and services (including through automated technologies described in our Privacy Notice).

Email*

Phone calls and texts*

I read and agree to the use of my personal and sensitive data described in the Privacy Notice below*

I have read and agree with the other Terms and Conditions associated with this service*

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