JOIN OUR COMMUNITY - Medical Professionals

If you are a medical professional currently involved in the treatment of CAH patients OR if you are interested in learning more about CAH treatment and research, use this form to JOIN OUR COMMUNITY

Prefix *

First Name *

Middle Name

Last Name *

Suffix

Practice/Hospital Name (if using work address)

Department (if using work address)

Address 1 *

Address 2

City *

State *

Zip *

Country *

Province (non-USA only)

Postal Code (non-USA only)

Address Type *

Phone *

Phone Type *

Phone2

Phone Type 2

Email *

Email 2

Fax

Web Site

M: Are you a medical professional? *

M: Are you an EMS professional? *

M: Are you a newborn screening professional? *

M1: GENDER *

Profession Type - please check all that apply *

N/A
Adrenal Surgeon
Adult Endocrinologist
Adult Endocrinologist/Internist
Adult Urologist
Adult Urologist & Surgeon
Assistant Clinical Prof.
Assistant Prof. of Pedicatrics
Behavioral Health Specialist
Biochemist
Child Psychiatrist
Child Psychologist
Dermatologist
Electrologist
EMS
Endocrinologist
Endocrinologist - Pediatric & Adult
Endocrinology Nurse
Ethicist
Family Practice Physician
Genetic Counselor
Geneticist
Hematologist
Hospital Administrator
Internist
Internist/Endocrinologist
Midwife
Neonatologist
Neuroendocrinologist
Neurologist
Newborn Sceening Director/Facilitator
Newborn Screening Research
Nurse (LPN)
Nurse (RN)
School Nurse - Public School
School Nurse - Private School
Nutritionist
OB/GYN
OB/GYN & Genetics
OB/GYN - Pediatric & Adolescent
OB/GYN-Reproductive Endo
PARAMEDIC
Patient Advocate
Pediatric Endocrinologist
Pediatric Endocrinology Fellow
Pediatric Nurse Practitioner
Pediatric Surgeon
Pediatric Urologist
Pediatrician
Pharmacist
Professor
Psychiatrist
Psychoendocrinologist
Psychologist
Public Health Professional.
Radiologist
Reproductive Endocrinologist
Research
Scientist
Social Worker
Surgeon
Urogynecologist
Urologist
Writer
Other

M: Do you currently treat CAH patients? *

M: Are you interested in being added to our referral list? *

M: Are you interested in CAH research and/or treatments? *

M: Please give us your practice name and address (unless listed as primary address above) *

M: Please give us your hospital affliliation, name and address (unless listed as primary address above) *

Your Assistant/s Name/s:

Assistant/s Email/s and Phone number/s:

Are there any topics that you would like to see covered in an upcoming newsletter or conference?

Would you be interested in contributing an article to the CARES Foundation newsletter? If so, what topic?

Your message

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JOIN OUR COMMUNITY - Medical Professionals