*1.What is your name (First and Last)?(Required.)

*2.What is your mailing address?(Required.)

*3.What school district do you serve and what grade(s)?(Required.)

*4.What is your email address?(Required.)

*5.How many copies are you requesting (If more than 1, please indicate who the additional copies are for)?(Required.)

*6.Were you previously aware of PANDAS/PANS and that it affects 1 in 200 children presenting as psychiatric or behavioral when in fact it has medical causation that requires treatment by a medically competent PANDAS/PANS provider?(Required.)

Yes

No

*7.Would your team or school district be interested in a FREE presentation on PANDAS/PANS from our local nonprofit? If so, we will reach out to contact you.(Required.)

Yes

No

Possibly

PLEASE REFER ANY FAMILIES SUSPECTING THIS DISORDER OR WHO HAVE A PANDAS/PANS CHILD TO OUR NONPROFIT’S WEBPAGE TO JOIN OUR COMMUNITY AND LEARN ABOUT OUR SERVICES.

Thank you for requesting your FREE copy of PANDAS/PANS in the School Setting. To learn more about these disorders, please visit www.nwppn.org or email us at nwestppn@gmail.com