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Half of the ALS patients survive less than 3 years, and 80% of the patients survive less than 5 years. Riluzole is the only approved medication in Canada with randomized controlled clinical trial evidence to slow the progression of ALS, albeit only to a modest degree. The Canadian Neuromuscular Disease Registry (CNDR) collects data on over 140 different neuromuscular diseases including ALS across ten academic institutions and 28 clinics including ten multidisciplinary ALS clinics. <jats:bold>Methods:<\/jats:bold> In this study, CNDR registry data were analyzed to examine potential differences in ALS care among provinces in time to diagnosis, riluzole and feeding tube use. <jats:bold>Results:<\/jats:bold> Significant differences were found among provinces, in time to diagnosis from symptom onset, in the use of riluzole and in feeding tube use. <jats:bold>Conclusions:<\/jats:bold> Future investigations should be undertaken to identify factors contributing to such differences, and to propose potential interventions to address the provincial differences 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