Healthcare Professionals Application

Healthcare Professionals Application
Please complete this form to help us ensure that we hear from the full range of healthcare providers who diagnose and treat people with urea cycle disorders as we work to develop a new research roadmap
What is your profession?*
Please specify your profession if you selected "other," above
What type of patients do you see?*
What is your specialty? (you may choose multiple options)

Genetics (metabolic specialist)Genetics (general)Emergency medicineCritical careHepatologyNeonatologyNeurologyTransplant surgeryPediatricsPsychiatryPrimary careOther
Please specify your specialty if you selected "other," above
How many years have you been in practice?*
What percentage of effort do you devote to research? *
Please enter two numbers; field will not display the % sign
Are you a current or past member of the Urea Cycle Disorders Consortium (UCDC)?*

YesNo
Approximately how many patients with a urea cycle disorder have you seen in your career?*
Your Demographics

We are collecting this information about you as a potential Partner Network member to help ensure the network includes a diverse sample of the UCD community, allowing us to capture a range of healthcare professional experiences. All information will be kept strictly confidential.
Which best describes your gender?*
What year were you born?*
Please select what you consider your race to be (you can select more than one)*

WhiteBlack or African AmericanHispanic or LatinoAmerican Indian and Alaska NativeAsianNative Hawaiian and Other Pacific Islander
In which country do you currently reside?*
In which state do you currently reside?
Are you able to participate in an English language focus group?*

YesNo
Your Contact Information
Name*

First NameLast Name
Email*
example@example.com
Phone Number (needed in case our emails don't reach you)*
Please enter a valid phone number.
I agree that you may contact me via text messaging (msg and data rates may apply)*

YesNo
Please verify that you are human*
Thank you for your interest in joining the NUCDF Partner Network project. We will be reaching out to selected network members in Fall 2025. To follow news about this project, please subscribe to our newsletter at at https://nucdf.org.
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Healthcare Professionals Application

Please complete this form to help us ensure that we hear from the full range of healthcare providers who diagnose and treat people with urea cycle disorders as we work to develop a new research roadmap

Your Demographics

Your Contact Information

Thank you for your interest in joining the NUCDF Partner Network project. We will be reaching out to selected network members in Fall 2025. To follow news about this project, please subscribe to our newsletter at at https://nucdf.org.