If you are a healthcare provider experienced in the treatment of people with hypersomnias, please Join Our International Healthcare Provider Directory by completing the form below. To search the directory, click HERE. Prefix *Select one...Dr. (Mr.)Dr. (Ms.)Dr. (Mx.)Mr.Ms.Mx.First Name *Last Name *SuffixEmail *Although we are requesting this information, we will not publish your email address.In order to determine what additional information to collect, we need to know what kind of provider you are. Please select an option from the following drop-down.I am a:Select one...I hold the following degree(s) *If your degree/credential is not listed here, see this list of equivalents.Please check all that apply.Other Degree(s)Institution or Organization Affiliation (enter n/a if no affiliation) *Address *Country *Select CountryState/Province *Select StateCity *Select CityZip/Postal Code *Office Phone *Not a valid phone number.Website (enter n/a if you don't have a website) *Please enter your personal page on your organization's website, your LinkedIn profile, or similar. Help new patients learn the most about you.Specialty/Provider Type *Please check all that apply.Other SpecialtiesI treat patients with the following conditions *Please check all that apply. Idiopathic Hypersomnia Kleine-Levin Syndrome Narcolepsy None of the AboveNumber of patients (new and returning) I treat in a month with idiopathic hypersomnia *Select one...01-56-1011-1516-2021+Number of patients (new and returning) I treat in a month with Kleine-Levin syndrome *Select one...01-56-1011-1516-2021+Number of patients (new and returning) I treat in a month with narcolepsy *Select one...01-56-1011-1516-2021+I am accepting new patients *Select one...YesNoI treat *Please check all that apply. Adults ChildrenI conduct clinical research on hypersomnias *Select one...YesNoBy 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 AgreeI would like to receive complimentary brochures from the Hypersomnia Foundation to distribute in my office.Click here to print your own. Yes How many brochures do you expect to distribute within the next 6 months? *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. YesHow many cards do you expect to distribute within the next 6 months? *I would like to receive complimentary Anesthesia and IH guides from the Hypersomnia Foundation. Or download/print HERE.Click here to print your own. YesHow many guides do you expect to distribute within the next 6 months? *Is there anything else you would like us to know about you? I would like to Stay in Touch with the Hypersomnia Foundation.SubmitThank you!We will review your submission and get back to you if necessary.
