Clinician & Researcher Network

First Name

Last Name

Email

City

State/Region/Country

Institution/Organization Affiliation

What is your primary specialty?

Select the 17q12 CNV you study/treat

17q12 deletion

17q12 duplication

Both 17q12 deletions and duplications

Describe your role with 17q12 CNV research and/or clinical care.

I currently treat patients with 17q12

I have treated patients with 17q12 in the past

I am currently conducting research on 17q12

I have conducted 17q12 research in the past

I am interested in conducting 17q12 research

I am interested in treating patients with 17q12

I am not interested in treating patients or conducting research at this time

Additional Comments