Healthcare Providers: Join Our International Directory

I hold the following degree(s) *
If your degree/credential is not listed here, see this list of equivalents.
Please check all that apply.

Institution or Organization Affiliation, or your practice name*I don’t wish to provide an Institution/Organization/Practice name.

Mailing Address *
(only your city/state/country will be displayed on our directory)
I only provide telehealth services.

Country *
Select Country

State/Province * Select State

City * Select City

Zip/Postal Code *

Office Phone * (best number for patients to schedule appointments)
Not a valid phone number.

Extension (if applicable)

Website*
Please enter your personal page on your organization’s website, your LinkedIn profile, or similar. Help new patients learn the most about you and your clinical practice.

Specialty/Provider Type *
Please check all that apply.

I treat patients with the following conditions *
Please check all that apply.
  Idiopathic Hypersomnia
  Kleine-Levin Syndrome
  Narcolepsy
  None of the Above

Number of patients (new and returning) I treat in a year with idiopathic hypersomnia *Select one…01-1011-2021-3031-4041-50More than 50

Number of patients (new and returning) I treat in a year with Kleine-Levin syndrome *Select one…01-34-67-910 or more

Number of patients (new and returning) I treat in a year with narcolepsy *Select one…01-1011-2021-3031-4041-50More than 50

Help HF gather information on reaching underrepresented patients. Approximately what % of your patients with primary hypersomnias (IH, narcolepsy, or KLS) are members of underrepresented racial/ethnic groups?Select one…0%1-10%11-20%21-30%31-40%41-50%More than 50%

I am accepting new patients *Select one…YesNo

I treat *
Please check all that apply.
  Adults
  Children

I conduct clinical research on hypersomnias *Select one…YesNo

By submitting this form, I agree to have my information added to the Hypersomnia Foundation’s Healthcare Provider Directory. I understand that inclusion in the directory does not imply endorsement by the Hypersomnia Foundation. *
  I Agree

I would like to receive complimentary brochures from the Hypersomnia Foundation to distribute in my office.
Click here to print your own, or share this link with your patients so they can view/print their own.
  Yes

I would like to receive complimentary IH medical alert cards from the Hypersomnia Foundation to distribute in my office.
Click here to print your own, or share this link with your patients so they can print their own fillable PDF cards.
  Yes

I would like to receive complimentary Anesthesia, Hospitalization and IH guides from the Hypersomnia Foundation.
Click here to print your own, or share this link with your patients so they can view/print their own.
  Yes

Is there anything else you would like us to know about you?

  I would like to Stay in Touch with the Hypersomnia Foundation.

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