Update Your Information

For current members to provide HAE Canada with updated information.

Name

First Last

Please enter the name you provided when you joined HAE Canada so we can find you in our membership database.

New Name

First Last

To be completed if you have recently changed your name

Address

Street Address Address Line 2 City Province Postal Code

Cell Phone

Home Phone

Are you a:

Patient: Type 1 or 2

Patient: HAE with normal C1 (formally called Type 3)

Patient: Acquired Angioedema

Family Member / Caregiver

HAE Specialist's name:

Other Comments