The goal of the Patient Registry is to understand the needs of individuals with paralysis, aphasia, hearing loss and/or visual impairment.

Instructions

• Click "Continue" below to fill out the forms required to join Neuralink's Patient Registry. You may use your legally authorized representative to fill the forms on your behalf if you are physically unable to do so yourself.
• Applications are closed to those outside of the U.S., those under the age of 18 or under the applicable age of majority in their state, and those not able to consent or provide or signal consent to their legally authorized representative.
• There is no time limit to complete the application. Your application will be saved in your browser, and you can return to it between sessions, unless you click the “SUBMIT” button. Once you click “SUBMIT” you may no longer go back to edit your application.
• If you no longer wish to submit your application, you may exit this application by closing the window or tab at any time before you click “SUBMIT”. No information will be collected by Neuralink until you click “SUBMIT”.
• Items marked with an asterisk (*) are required.

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If you are a legally authorized representative (LAR) completing the Patient Registry application on someone else’s behalf:

• Please only fill out this application on behalf of the participant if the participant is able to consent for themselves, but is unable to physically complete the application on their own behalf.
• Prior to using any Patient Registry information you provide on behalf of the individual you represent, Neuralink may contact you if additional information or documentation is required to confirm your relationship with the Patient Registry participant you represent.