Register

Retina UK Portal registration form

Name
First Name Last Name
Email*
Confirm Email*
Please enter your email address again and check you have typed it correctly.
Password
Tick this box to Show Password when you enter it in the field below
Enter Password*
Like many sites, this portal will not accept weak passwords for security reasons. To make it stronger, use upper and lower case letters, numbers and symbols like ! ” ? $ % ^ & )

Strength indicator
Some of the information you share with us will be sensitive, such as information about your health. We ask for this to enable us to deliver, monitor and assist with this service. Just for your information, your personal details will be collected on our behalf by Arthur Ellis.
Consent*
If you are happy for us to process your data, please tick the box
And remember, you can change your consent any time by contacting Retina UK at Wharf House, Stratford Road, Buckingham MK18 1TD, by telephoning 01280 821334 or by emailing Wellbeing@Retinauk.org.uk Full details on how we use your information can be found in our privacy policy at www.retinauk.org.uk/privacy
Phone
This field is for validation purposes and should be left unchanged.