Add/Update Your Information

Provide your information below for consideration in the Local Resources on Parkinson.org as a Health Care Professional.

Required Information
Full Name
Organization Name
Address 1
Address 2 (Optional)
City
State/Province
Zip Code/Postal Code
Country
Phone Number
Email Address
Your Discipline	Select One None Internal Medicine Music Therapy Neurology Neuropsychiatry Neurosurgery Nursing Nutrition Occupational Therapy Pharmacy Physical Therapy Psychiatry Psychology Social Work Speech-Language Pathology Other
	If Other, please specify.
Your Degree
Are you part of an NPF Center?	If yes, please specify.
Have you completed NPF Allied Team Training for Parkinson (ATTP)?	If yes, please specify location and year.
Percentage of patients you treat who have Parkinson's disease	Use numbers only, no % sign. If none, please use a “0”.
Please type the characters you see in the image to the right
Optional Information
Web site
Affiliation with other Parkinson's disease Center or organization
Additional Information