GSCDN Sickle Cell Disease Centre Information Collection Form

Please complete this form and assist the Global Sickle Cell Disease Network (GSCDN) in collecting information to populate an interactive map for the GSCDN website.

** Please note, each Sickle Cell Disease Centre will need to be entered as a separate submission using this form.

Country*  

National strategies for sickle cell disease control  

Region*  
City*  
Sickle cell disease centre*  
Address*  
Website

Hours of operation
(please use 24 hour format when entering hours of operation e.g. 08:00-16:00)    
Time Zone  

Services offered*
Clinical*









 
Laboratory*






 

Newborn Screening*  

Research Activities  

Funding source(s)*



 

Main Contact for Sickle Cell Disease Centre:
Title*  
First name*    
Last name*    
Position*    
Telephone*    
Email Address*    
Please enter the security code as shown in the image