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Registry for Medical Professionals
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Health Care Provider
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First Name:
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Last Name:
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Hospital, Clinic or University
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Address
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City
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State
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Zip Code
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Country
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Work Phone
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Fax
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E-Mail Address
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Professional Certifications
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MD
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RN
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PhD
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Therapist
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FACMG
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LPN
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MSN
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Other(Specify)
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Practice Specialty
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Pediatrics
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Speech Therapy
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Neurology
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Physical Therapy
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Genetics
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Occupational Therapy
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Family Practice
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Other(Specify)
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PND Patient Population
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Tyrosine Hydroxylase Deficiency
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Aromatic L-Amino Acid Decarboxylase Deficiency
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GTP Cyclohydrolase I Deficiency(Dopa Responsive Dystonia)
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Succinic Semialdehyde Dehydrogenase Deficiency(SSADH)
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Permission Requests
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Yes No
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Can we provide your information to other medical professionals?
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Can we provide your information to families seeking assistance with a PND?
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