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

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* 1. Please give the following information:

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* 2. What is your profession?

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

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* 4. How long have you been in practice?

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

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

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

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

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* 9. Do you diagnose patients yourself?

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

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100% of survey complete.

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