Access to care questionnaire

Access to adult care for patients with Turner Syndrome
Turner Syndrome Foundation is your advocate. Let us know what is important to you!
My connection to TS*
Name*

First NameLast Name
Birthdate*

MonthDayYear
Age of Diagnosis*
E-mail*

Confirmation Email
State*

Street Address

Street Address Line 2

CityState

Zip Code
I live within __ hour(s) of a major city.*

1 or less234more than 4
It is difficult for me to find:*

Adult CarePediatric CareMaternal Care - Carrying a child with Turner SyndromeI can find appropriate care
In my area, I can find:*

A TS Specialized Care CenterCardiac CarePediatric Endocrine CareAdult Endocrine CareReproductive/Fertility CarePsychological CareHearing CareEye/Sight CareI am not looking for these.
In my area, I cannot find:*

A TS Specialized Care CenterCardiac CarePediatric Endocrine CareAdult Endocrine CareReproductive/Fertility CarePsychological CareHearing CareEye/Sight CareI am not looking for these.
In my area, I can easily find:*

Access to a specialized healthcare center for Turner SyndromeHealthcare providers with knowledge about Turner SyndromeEducators who can create an optimal learning environmentPatient educationCaregiver educationSupport groupsTeam TSF awareness eventsLegislative advocacyFundraising efforts to benefit TSF
I have a copy of the NIH Clinical Care Guidelines for Turner Syndrome.*

YesNoNever heard of this, please send me a copy!
Send me:

News and AnnouncementsResearch InformationWays to Get InvolvedA donation pledge form
Questions or concerns:*
KNOW A GOOD PROVIDER?

Share contact info for a provider, or two, whom you have found to be helpful or knowledgable. Thank you for sharing!
Practice Name:
Doctor's Name:
Tele#:
Specialty

Family CareAdult CarePediatric CareEndocrinologyInternistGynecologyCardiologyENTGastroenterologistAutoimmunologistPsychotherapistNeurosychologistLearning specialistOther
Additional info:
Should be Empty:

Access to adult care for patients with Turner Syndrome