Prader-Willi Syndrome Providers - Add a new Entry

Thank you for providing us with information about your agency.
All entries must be approved by our Provider Advisory Board.  It may take a few weeks before your entry will appear.


Agency/Provider Organization Information

Mailing Address (if Different|)

Agency Name Street Address
Contact Person Address (cont.)
Contact Title City 
Street Address State/Province  
Address (cont.) Zip/Postal Code
City     
State/Province   Who is filling out this form?
Zip/Postal Code Name
       
Phone:    
FAX    
E-mail    
Website    

Types of Services

Residential Supports Day Services Vocational Program
Private School Residential School Case Management
Counseling/Therapy Medical Supports Psychiatric/Psychological
Crisis Supports Respite Other
  • How many individuals with PWS are currently being supported?
  • What is the age range of individuals with PWS ?
    Birth to 3yrs
    4yrs to 17 yrs
    18yrs to 20yrs
    21 yrs and older
  • Do you provide Prader-Willi Specific Programs? 
  • How long has the agency been supporting individuals diagnosed with PWS (since what year? Example - 1999)?

Give a brief service description:

Current Environmental Supports:

24 Hour Supervision 24 Hour awake Supervision Food Safety/Locks
Menu/Meal Planning Dietician Exercise Program
Individual Service Plan Behavioral Supports Other

Do you take out of state placements?

Types of Funding:

State County Medicaid
Medicaid Waiver Private Insurance Private Pay
Education Other
  • Is your agency a current member of PWSA (USA)?
  • Would you like your contact information posted on the PWSA (USA) website?

The following questions are for office reference only in order to improve support provided by PWSA (USA)!

  • Do you attend annual PWSA (USA) conferences?
  • When was the last conference you attended?
  • What types of topics would you like covered at the Conferences?
  • What barriers prevent you and your staff from attending the annual national conference?
    (Cost/Time/Location/Administrative support?
  • Do you currently utilize PWSA (USA) as a resource?
  • Outside of PWSA-USA, what additional resources do you utilize?
  • What types of supports would be helpful to the success of your program for individuals with PWS? (i.e. Phone support, on site visits, technical, training materials..)
  • Would you be interested in being a part of the e-support provider network group?

Thank you so very much for your time…

 
Copyright © 2005 Prader-Willi Syndrome Association (USA)]. All rights reserved.
Revised: 04/11/11