Provider Name

Provider Email

Provider Phone

Practice ZIP code

What is Your Role at Practice?
Provider or practice ownerOffice managerReceptionistOther

State
AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming--District of ColumbiaPuerto RicoGuamAmerican SamoaU.S. Virgin IslandsNorthern Mariana Islands
 

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Speciality
AcupuncturistAllergistAnesthesiologistAsthma EducatorAudiologistBariatric PhysicianBioidentical Hormone DoctorCardiac ElectrophysiologistCardiologistCardiothoracic SurgeonChild Abuse Pediatrics SpecialistChiropractorColorectal SurgeonCoronavirus Testing FacilityCOVID-19 Testing FacilityCOVID-19 Vaccination FacilityCystic Fibrosis CoordinatorDentistDermatologistDevelopmental-Behavioral Pediatrics SpecialistDietitianDietitian / NutritionistEar, Nose & Throat DoctorEmergency Medicine PhysicianEndocrinologistEndodontistEpidemiologistEye DoctorFamily PhysicianFlu Vaccination FacilityGastroenterologistGeneticistGeriatricianHand & Microsurgery SpecialistHand SurgeonHand TherapistHearing SpecialistHematologistHospice and Palliative Medicine SpecialistHospitalistImmunologistInfectious Disease SpecialistInfertility SpecialistIntegrative Health Medicine SpecialistInternistLaboratory Medicine SpecialistLactation ConsultantMedical EthicistMicrobiologistMidwifeMonkeypox Vaccination FacilityNaturopathic DoctorNephrologistNeurologistNeuromusculoskeletal Medicine & OMM SpecialistNeuropsychiatristNeurosurgeonNurse PractitionerNutritionistNutritionist_oldOB-GYNOccupational Medicine SpecialistOccupational TherapistOncologistOphthalmologistOptometristOral SurgeonOrthodontistOrthopedic SurgeonOtolaryngic AllergistPain Management SpecialistPathologistPediatric DentistPediatric Emergency Medicine SpecialistPediatric Hematologist / OncologistPediatric Transplant HepatologistPediatricianPeriodontistPhysiatristPhysical TherapistPhysical Therapist & PhysiatristPhysician AssistantPlastic SurgeonPodiatristPreventive Medicine SpecialistPrimary Care DoctorProsthodontistPsychiatristPsychiatrist / PsychologistPsychologistPsychosomatic Medicine SpecialistPsychotherapistPulmonologistRadiation OncologistRadiologistReproductive EndocrinologistRespiratory TherapistRheumatologistSleep Medicine SpecialistSpeech-Language PathologistSports Medicine SpecialistSurgeonSurgical OncologistThoracic SurgeonTravel Medicine SpecialistUrgent Care ClinicUrgent Care SpecialistUrological SurgeonUrologistVascular SurgeonWound Care Specialist
 

Medical Condition

 

Please Describe Your Medical Condition in Your Words.

 

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