Doctor list update

Here is a 10 question survey to update our EDS Friendly Doctor List. Please complete the form for each doctor you would like to recommend. You may fill out the form multiple times. The required information is:

  • Doctor’s name
  • Doctor’s specialty
  • Doctor’s phone number
  • Doctor’s address
  • Doctor’s website (optional)
  • Your name
  • Your email
  • Your notes on the doctor

Only the doctor’s information will be shared with the group.

Your name, email and notes will not be published but will enable me to follow up for clarifications and corrections. Your information is required to make a recommendation.

If a doctor has 2 or more offices please add the second one in the last free-form text box about your notes on the doctor.

Welcome to your Doctor list update

Doctor's first name
Doctor's last name
Doctor's specialty
Doctor's phone number  (no punctuation, like: #########)
Address street and number
City, state and zip code
web site (optional)
Your name
Your email
Please describe your experience with the doctor