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IFFGD Patient Resource Form

We are often contacted by patients who wish to find a healthcare professional in their area. If you would like to be listed as a patient resource, please fill out this form and submit it to IFFGD. Thank you.

Patient Care Contact Information (To be displayed on the Patient Resource List)

Administrative Contact Information (Not viewable to patients; for IFFGD use only)

Please select all of the following that apply to your practice:

To select multiple options, hold down the control (ctrl) button