AFE Patient Registry

Submit a Case

Amniotic fluid embolism (AFE) is a rare occurrence making it difficult to study. The AFE Foundation and Baylor College of Medicine in Houston, Texas have formed the Amniotic Fluid Embolism Registry, a database of AFE cases to allow researchers the ability to advance their knowledge of the condition and develop a means for prevention and treatment.

Surviving patients or family members of a loved one lost to an amniotic fluid embolism are encouraged to submit their case. Complete the information below to begin the process. A research coordinator from the AFE Foundation will respond in 7-10 business days to provide you with more information and the necessary paperwork to enroll.

If you are a health care provider, please submit the information and omit the patient’s name. We will work with you to consent the patient or their family member.

Learn more about our research and frequently asked questions.

Your Name (required)

Your Email (required)

Your Phone # (required)

Your Mailing Address (required)

Who are you submitting the case for? (required)
YourselfFor a loved one

Patients Name (required)

Date of AFE (required)

Comments or notes

If you have any questions or comments please feel free to contact us at info@afesupport.org