Northwest PANDAS/PANS Network

Northwest PANDAS/PANS Network

Your LOCAL 501c3 nonprofit. Serving Oregon, Washington and Idaho.
Name:*

First NameLast Name
Email*
example@example.com
Facebook name if requesting to join our parent/caregiver group
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
State*
City*
Have you or your child been diagnosed with PANDAS/PANS?*

YesNo
If yes, who diagnosed them and when?
Requesting*

Referral to PANDAS/PANS providerCrisis SupportSchool Support (504/IEPs, etc.)Join Facebook GroupOther
How did you hear about our nonprofit serving the Northwest?*

Medical providerBehavioral health providerEducatorGoogle searchSocial mediaFriendFamilyConferencePresentation by NWPPNAdvertisementChat GPTOther
- Current Age*
- Age at Onset*
- Symptoms you or your child is experiencing:*
  
  OCDUrinary FrequencyTicsSuicidal ideationEating RestrictionsSuicide attemptAnxietyEmotional LabilityDepressionAggression/RageBehavioral RegressionHandwriting ChangesADHDSensory SensitivitiesSleep DisturbancesUrinary incontinence (Enuresis)School refusalOther
- Anything additional you would like us to know
- Who responded to initial inquiry via email?
  
  KymSarahCarlySueSarah & KymOther
- Response sent
  
  MonthDayYear
  Date
- Referred to:
  
  Dr. GbedawoDr. ParavinciDr. McallisterDr. HanceyDr. PhillipsDr. Jenny WilsonDr. JainDr. KovacevicAmy SmithDr. PayneDr. ChapmanDr. McCartyDr. KirchoffDr. DayDr. HillDr. SteinDr. EberhardtDr. MessingerMelissa KidbyJordan SirtoliJennifer BoudreauxJillian EhrlichDr. PlawnerDr. SquiresDr. DahlgrenDr. DerksonAaron DykstraDr. BrusCarey CrillDr. DandyDr. OharaDr. Kiki ChangDr. WilmsDr. BedfordTamara BroadheadDr. Doug LincolnNicole GansemerManuel SierraCPAEDr. BowkerDr. Dossetter (Kaiser)Dr. Duft (Kaiser)Paige McAfeeKali Doyle, NPAlison Christy, MDTheo Badger, NDAyla Wilson, NDJordana Hawkins, MDSayre Limburg, NDRachel Roth, MDKristen Giseler, NPJennifer Means, NDAlexandria St. Claire, NDJeffrey Hancock, MDJenifer Benally/Lisa LeazenbyMickey Kander, PAMichael Lehman, NDDavid Hjellen, MDMichelle Grimes, PsychologistAlex Serkalow, NDKarmazin Katmazin, MDJohn Whelan, MDBeth Latimer, MDSpencer Augustin, MDAlaska Chidrens Urgent Care-Jennifer AustinMindy Choe, NPKatherine Leatherman, PMHNPCody Seeley, DOJessica Perley, FNPClayton Sontheimer, MDOther
- Comments:
- Diagnoses to Date:
  
  ADHDOppositional Defiance Disorder (ODD)Cognitive ReframingAutismMast cellAnxietyThyroid conditionOCDImmunodeficientEhler DanosLymeDepressionDown syndromeRole PlayMold ToxicityArfidMirroringOther
- School Status:
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  Date
- Notes:
- Date
  
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- Notes:
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- Notes:
- Date
  
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- Notes:
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- Notes:
- Should be Empty: