Clinician & Researcher Network

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Calling all 17q12
Clinicians & Researchers!

Join the 17q12 Clinician & Research Network

First Name

Last Name

Email

City

State/Region/Country

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. * Required

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

Institution/Organization Affiliation

Additional Comments

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©2021 17q12 Foundation. All rights reserved. The 17q12 Foundation is a registered 501(c)(3) organization. The 17q12 Foundation does not recommend or endorse any particular medical treatment but encourages patients to seek the advice of their clinicians.

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Calling all 17q12 Clinicians & Researchers!

Join the 17q12 Clinician & Research Network

Calling all 17q12
Clinicians & Researchers!