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SUBMIT YOUR PROVIDER

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Submit your Provider

Do you have a great doctor, therapist, or other medical professional who has helped you manage your FND that isn't listed in our Provider Directory?   Submit the information so we can get them listed and help other patients find them. 

Are you a medical professional who isn't listed here but who treats FND and wants to be listed?  Submit your information so we can get you listed and help patients find you. 

Please tell us if you are submitting information on a provider that you, as a patient, see/have seen or if you are a medical professional submitting your own information.
Medical Professional's Contact Information
Please enter the department of your organization. For example, if you are at Northwestern University in the Movement Disorders Clinic, Northwestern University would be your organization and the Movement Disorders Clinic would be your Department.
If the medical professional has a profile web page that gives an overview of their expertise and/or treatment methodology, please include it here.
Some patients have a preference for gender of their treatment physician. Please include this information to help patients select a provider if this criteria is important for them.
Is a referral needed to see this physician?

Please enter your organization. This is this highest level of the place you work. For example, if you are at Northwestern University in the Movement Disorders Clinic, Northwestern University would be your organization and the Movement Disorders Clinic would be your Department.
Please enter the website for the organization/office/program that would give patients more info.
Please enter the phone number for the organization/office where patients would call to make an appointment.
Please enter the organizational address where the patient would visit for appointments, rather than a mailing address.

Expertise in FND

This section outlines specifics about the type of expertise the medical professional has.  It will help patients identify practitioners that may offer the types of services they need.  

Medical Speciality
Does this medical professional diagnose FND?
Service Offerings
Select all of the type of service offerings that are available from this provider.
Does your medical professional/you offer other services not listed above? If so, please add them here.

This section is most relevant for medical professionals who are filling this out themselves.  It is unlikely that patients would have this level of detail.  Feel free to leave blank if you are a patient submitting their medical professional.   If you are a medical professional, filling in this level of detail will help patients find a practitioner who is a good fit for their needs. 

If you have a written description of your expertise and experience that would help patients understand your treatment offerings and philosophy, please enter it here.
FND Professional Training
Select all the types of specialized training you have received on FND.
If you have other types of professional training in FND, please list them here.
Enter the year you began working your practice, regardless if you were treating FND then. This will help patients understand how long you've been working professionally.
Enter the year you began working with patients with FND. This will help patients understand how long you've been working the condition.
Approximate number of FND patients practitioner has treated in the past 5 years
Select the approximate percentage of practitioner's patient load that have FND
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