Clinician Recommendation Form

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For those of our families who do not visit a Dup15q Clinic, we want to generate a directory of family-approved physicians who are familiar with Dup15q syndrome. Please complete the form for any specialist or general practitioner your child currently sees that has been favorable, and we will generate a resource on the Dup15q Alliance website!

What is your clinician's name? *

In what city and state is their practice located? *

What is their specialty? *

General Medicine

Neurology

Psychiatry

Gastrointestinal

Speech Therapy

Occupational Therapy

Physical Therapy

Genetic Counselor

Nutritionist

Other:

Required

Do they see both kids and adults? *

Just kids

Just adults

Both

I'm not sure

Thank you so much for sharing! Do you have any additional comments of things we should know before adding this doctor to our directory? *

Submit

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