Join the RLS Foundation Healthcare Provider Network

The Foundation is working hard to identify additional healthcare providers with experience in treating and managing RLS. Although we offer 13 Quality Care Centers, 11 of which are located in the US, there is still a need for providers in all 50 states. If you have RLS treatment experience, please complete the following to join our RLS Provider Network.

Question Title

* Healthcare Provider Information

Name

Address

Address 2

City

State

ZIP

Scheduling Email

Scheduling Phone

Question Title

* Number of new/follow-up RLS patients you treat in a month

1-5

6-10

11-15

16-20

21+

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* Specialty

Family Medicine

Internal Medicine

Neurology

Psychiatry

Sleep Medicine

Other (please specify)

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* Professional Organization Memberships

AASM

AAN

Other (please specify)

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* Do you give the RLS Foundation permission to publish your contact information on www.rls.org as an experienced RLS healthcare provider?

Yes