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Please join our International Clinician Database of those seeing NBIA individuals for any of the disorders under the NBIA umbrella. We will keep you updated on the latest research news, send information on treatments and therapies available for NBIA individuals and if you wish, add you to a clinician list to be in contact with other clinicians in the database and/or one available to NBIA families looking for a doctor.

You may also have an opportunity to participate in our International NBIA Patient Registry with natural history study information that will help us prepare for clinical trials.

International Clinician Database - Join Now:

  1. First Name(*)
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  2. Last Name(*)
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  3. Street Address(*)
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  4. Address Line 2
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  5. Address Line 3
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  6. City(*)
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  7. State(*)
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  8. Postal Code(*)
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  9. Country(*)
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  10. Telephone(*)
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  11. Email(*)
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  12. Type of Doctor(*)
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  13. Do you have contact with NBIA individual(s)?(*)
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  14. If yes, what form(s) of NBIA do they have? (Check all that apply)














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  15. I wish to receive information on research grant applications when available
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  16. I would like email updates on NBIA research news
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  17. As a clinician who has seen/is seeing an NBIA individual, I agree to have my contact information listed in a physician directory to be shared with other clinicians seeing NBIA individuals
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  18. As a clinician who has seen/is seeing an NBIA individual, I agree to have my contact information listed in a directory to be shared with NBIA families looking for a clinician who has some experience with NBIA disorders
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  19. As a clinician who has seen/is seeing an NBIA individual, I am interested in learning more about participating in the NBIA International Patient Registry (some compensation for participating)
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  20. Additional Comments
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  21. For security reasons, please enter the letters(*)
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