Enter your physicians information

We are putting together a database of physicians who treat myositis. Your input is greatly appreciated. 

* 1. Name of Physician

* 2. Physician Contact

* 3. Speciality

* 4. For which form of myositis does this doctor treat you?

* 5. How you would rank this doctor in terms of knowledge/experience with your disease?

* 6. How you would rank this doctor in terms of listening to your needs?

* 7. Add any additional notes about the physician you are listing

* 8. Your contact information (optional)

T