Registry for Medical Professionals
 
Health Care Provider

First Name: 
Last Name: 
Hospital, Clinic or University

Address

City
,
State
Zip Code
Country
Work Phone
Fax
E-Mail Address

Professional Certifications

MD RN
PhD Therapist
FACMG LPN
MSN Other(Specify)   

Practice Specialty

Pediatrics Speech Therapy
Neurology Physical Therapy
Genetics Occupational Therapy
Family Practice Other(Specify)   

PND Patient Population

Tyrosine Hydroxylase Deficiency
Aromatic L-Amino Acid Decarboxylase Deficiency
GTP Cyclohydrolase I Deficiency(Dopa Responsive Dystonia)
Succinic Semialdehyde Dehydrogenase Deficiency(SSADH)

Permission Requests

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Can we provide your information to other medical professionals?    
Can we provide your information to families seeking assistance with a PND?    
 


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