Submit a Doctor

Physician's First Name (required)

Physician's Last Name (required)

Degree (required)

Institution/Practice Name (required)

Address Line 1 (required)

Address Line 2

City (required)

State (required)

ZIP Code (required)

Country

Public Email

Office Phone (required)

Website

How many dystonia patients do you see in a month? (required)

What forms of dystonia do you treat?

Acquired (Secondary) DystoniaBlepharospasmCervical Dystonia/Spasmodic TorticollisDopa-Responsive DystoniaFocal Limb DystoniaFunctional DystoniaGeneralized - Childhood/Adolescent OnsetGeneralized - Adult OnsetMyoclonus-DystoniaOromandibular/Embouchure DystoniaParoxysmal Dystonia/DyskinesiasPrimary Torsion DystoniaRapid-Onset Dystonia-ParkinsonismSpasmodic Dysphonia/Laryngeal DystoniaWriters Cramp/Hand DystoniaTardive Dyskinesias/DystoniaX-Linked Dystonia-Parkinsonism

Do you treat children? (required)
YesNo

Do you offer telemedicine appointments? (required)
YesNo

Do you wish to join the DMRF mailing list? (required)
YesNo

Comments