FND Professionals Survey

The following survey is to identify providers that are interested in treating FND. It is meant for medical professionals to complete themselves, not for patients to submit information on behalf of their doctors. Please note not all information gathered from this survey will be available to patients. The purpose is to provide a concise reference for patients and providers looking for resources to refer patient with FND. The additional information requested through the survey may be used by the creators of the survey to better understand the landscape of providers wishing to participate in the care of patients with FND so that future attempts at gathering this information will be more precise and targeted as well as for demographic research.

An example of what will be available to providers and patients is below:

Dr. Jill Farmer
Neurologist, Movement Disorder Specialist
Actively treats Functional Movement Disorders
Outpatient Academic Clinic Setting
Drexel University
Philadelphia, PA
215-762-1949

Should you wish to add your name to this database, please complete the short survey.

We appreciate your participation. Should you have any questions, please contact Dr. Jill Farmer, Dr. Tim Nicholson, or Bridget Mildon.

Question Title

* 1. Please give the following information:

Salutation/Title

First Name

Last Name

Professional body/organisation number (e.g. MPI or GMC number)

Practice/Institution Name

City

State/County

Zip/Post Code

Country

Question Title

* 2. What is your profession?

Neurologist

Psychiatrist

Psychologist/Cognitive Behavioral Therapist

Physiotherapist/Physical Therapist

Occupational Therapist

Speech and Language Therapist

Other (please specify)

Question Title

* 3. Do you have an area of sub-specialty? (tick all that apply)

Movement disorder

Epilepsy

Chronic Fatigue Syndrome/Myalgic Encephalomyelitis

Gait/balance

Vision

No specialty

Other (please specify)

Question Title

* 4. How long have you been in practice?

0-1 years

2-5 years

6-10 years

11-15 years

16+ years

Question Title

* 5. How long have you been working with patients with FND?

0-1 years

2-5 years

6-10 years

11-15 years

16+ years

I have not worked with FND patients

Question Title

* 6. Which of the following describe your type of practice (tick all that apply)

Outpatient clinical practice

Inpatient clinical practice

Private

State-funded/Public

Teaching

Research

Other (please specify)

Question Title

* 7. Approximately how many FND patients have you treated in the past 5 years?

0-20

20-40

40-60

60-80

80-100

100+

Question Title

* 8. Approximately what percentage of your patients have FND?

none

I currently don’t provide specific treatment for FND but would be open to receiving additional information about FND.

1-10%

11-20%

21-30%

31-40%

41-60%

61+%

Question Title

* 9. Do you diagnose patients yourself?

Yes

Question Title

* 10. To what type of treatments do you refer patients? (tick all that apply)

Currently no referrals for treatment

Neurology - inpatient

Neurology - outpatient

Physiotherapy/Physical therapy - inpatient

Physiotherapy/Physical therapy - outpatient

FND specialized psychiatry - inpatient

FND specialized psychiatry - outpatient

Psychotherapy - general

Psychotherapy with FND specialist

Cognitive Behavioral Therapy (CBT)

Occupational therapy

Speech therapy

Hypnotherapy

Other (please specify)

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100% of survey complete.