IQVIA Connection Lung Cancer Registry

Power Lung Cancer Research. Share Your Story.

No one knows more about lung cancer than you. Join the registry and have a direct impact on the future of lung cancer care. Sharing your cancer experience is quick and confidential.

You can sign up if you:

Are at risk for lung cancer (this could be due to family history, exposures or smoking history)
Have a lung cancer diagnosis, are age 18 or older, and are able to make your own medical decisions.
Represent a child or dependent who has a lung cancer diagnosis and for whom you can legally make medical decisions.
Are a caregiver for a person who has a lung cancer diagnosis.
Represent someone who had a lung cancer diagnosis and is deceased.

The account holder is the person entering the data. This could be the person at high risk or diagnosed with lung cancer or a caregiver/representative.

Language

How did you hear about the Lung Cancer Registry?

If other, please specify

Your First Name (Account Holder)

Your Last Name (Account Holder)

What is your relationship to the person at-risk or living with lung cancer?

Confirm Email

Password

Confirm password

Your date of birth (account holder)

Your race (account holder)

Your ethnicity (account holder)

Did you ever serve in the armed forces, military reserves or national guard?

Your gender (account holder)

Do you think of yourself as?

Health Reason for Registration

Participant's First Name

Participant's Middle Name

Participant's Last Name

Participant's Birthdate

Participant's Race

Participant's Ethnicity

Did the participant ever serve in the armed forces, military reserves or national guard?

Participant's Gender

Participant's Sexuality

Participant's Country

Participant's City

Participant's State (USA Only)

Participant's Province (Outside USA)

Participant's Postal/Zip Code

Secondary Contact's Relationship to the Participant?

Secondary Contact's First Name

Secondary Contact's Last Name

Secondary Contact's Phone

Secondary Contact's Email

I agree to share my contact information with GO2 for Lung Cancer.

Do you want to receive communication from GO2 for Lung Cancer and the Lung Cancer Registry about surveys, research, published data, and clinical trials and other GO2 programs?

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