Joanne Zeis, Patient Pathfinders, PO Box 255, Uxbridge, MA 01569
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page before filling out this form.
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A PERSON WITH A RARE OR CHRONIC DISEASE
THE FAMILY MEMBER, CAREGIVER, OR FRIEND OF SOMEONE WITH A RARE OR CHRONIC DISEASE
A HEALTHCARE PROVIDER
IN THE U.S.
OUTSIDE THE U.S. AND CANADA
What is the name of the rare or chronic disease you (or the patient) has been diagnosed with?
Phone number with area code (optional)
I need information about:
UP-TO-DATE TREATMENT OPTIONS
SPECIALISTS AND/OR TREATMENT CENTERS THAT CAN TREAT THIS DISEASE
ONLINE OR IN-PERSON SUPPORT GROUPS
AVAILABLE CLINICAL TRIALS
GROUPS THAT MIGHT HELP PAY FOR MEDICATIONS
THE MOST RELIABLE ONLINE INFO SOURCES FOR THIS ILLNESS
THE MOST HELPFUL MEDICAL JOURNAL ARTICLES FOR YOU AND/OR YOUR DOCTOR(S)
QUESTIONS TO ASK YOUR DOCTOR(S) AT THE NEXT APPOINTMENT
OTHER (PLEASE DESCRIBE IN COMMENT / INFORMATION BELOW)
Comment / Information
Please provide only BASIC information or questions in this first contact! This form is not a secure (HIPAA-compliant) way to communicate, so personal health information given here might be seen by others.
A patient's primary care physician and/or medical specialists are
the best resources for any specific health situation.
Joanne Zeis of Patient Pathfinders does not offer
medical or legal advice, or diagnose or treat medical problems; she is neither trained nor qualified to offer these services. If you have questions about any of the information provided by Joanne Zeis and/or Patient Pathfinders, please direct those questions to the medical professionals handling the patient's care. ALWAYS ask these medical professionals for guidance
adding or subtracting any treatments (including alternative treatments and any "natural" or herbal preparations) based on any information provided by Joanne Zeis and/or Patient Pathfinders.
Information provided to you by Joanne Zeis and/or Patient Pathfinders will be as complete as possible within the accepted time and budget restrictions, but may not include all of the possible/available medical information, warnings, potential complications, or diagnostic, symptomatic, or research/treatment-related options. Any provided specialists' or treatment center names/locations are for informational purposes only; no guarantees are made about their ability to provide satisfactory, complete and/or cost-effective medical care.
As in life, there are also no guarantees that the patient will be helped or cured
by the researched medications, treatments, specialists, or healthcare facilities
ll medical and treatment decisions are
the responsibility of each client/patient.
I have read and accept the above statement.
I DON'T AGREE
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