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Database Update

Health Care Professionals 

 

PWSA (USA) is attempting to update their database with names and contact information for a variety of health care professionals that care for persons with Prader-Willi syndrome.  We appreciate your willingness to take the time to share this information with us.  This helps us to help others when someone is in search of a health professional that is knowledgeable of PWS in your area. 

NOTE: You will need to complete a new form for each health professional. 

Name of Professional

 

 

 

Title: Dr.

Last Name

MI

First Name

MD, PhD

Address

 

Address 2nd

 

City / State / Zip

 

 

 

City

State

Zip

Appointment Phone:

(     )

FAX#: (    )

Email Address

 

Type of Professional

Check all that apply

 Physicians:

 

Pediatrician   

 

Pediatric General Surgeon

 

Family Practitioner

 

Adult General Surgeon

 

Internal Medicine physician 

 

Surgeon who cares for both

 

Endocrinologist  Adult 

 

Orthopedist 

 

Pediatric Endocrinologist 

 

Ear, Nose and Throat 

 

Endocrinologist who cares for both  

 

Pediatric Pulmonologist / Lung Specialist

 

Pediatric Psychiatrist 

 

Adult Pulmonologist / Lung Special

 

Adult Psychiatrist

 

 

Pulmonologist / Lung Special who sees both

 

Psychiatrist who cares for both

 

Pediatric Ophthalmologist

 

Geneticist 

 

Adult Ophthalmologist

 

Gastroenterologist (stomach specialist)

 

Ophthalmologist who sees both

 

Neurologist

 

Podiatrist

 

 

 

Other

 

If Other, Please Explain:

Psychologist/Counselor

 

 

Dietician

 

 

Dentist Orthodontist

 

 

Other

 

Explain: 

Is the professional associated with a clinic or hospital? If yes- please indicate.

 

Does this professional speak languages other than English? If yes which ones?

Comments:

 

 

Person Completing form:

 

Date Information Obtained

 

 

Date Information Confirmed (PWSA staff only)