Dermatology Contact Survey
RequiredRequired Question(s)
Thank you for actually reaching this survey. That was the hard part. Now for the easy stuff.
 
Required
The PERSONAL INFORMATION requested below is YOUR name, YOUR email address and YOUR general location (no street address or postal code). This is NOT where you provide contact information for your dermatologist.

This personal information will NEVER be shared with third-parties, e.g., healthcare professionals, PRP researchers, pharmaceutical companies, etc. I use it to document the PRP patients and caregivers sharing the names of PRP-savvy dermatologists.


First Name:
Last Name:
Email Address:
emailaddress@xyz.com
State/Province
(US/Canada):
Country:


Please identify your primary dermatologist and his/her contact information. This should be the PRP-savvy dermatologist to whom you would refer a newly diagnosed PRP patient or caregiver. If, however, your dermatologist has NOT demonstrated the qualities of PRP savviness, enter N/A. My dermatologist was PRP savvy and I have NO problem referring and PRP patient in the Dallas-Fort Worth area to him.


Dr. Arturo Dominguez
University of Texas Southwestern Medical Center
5939 Harry Hines Boulevard, 4th Floor, Suite 100

Dallas, TX 75390

 

 

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Please identify any additional members of your Dermatology Team, e.g., dermatology physicians assistant, dermatology nurse, chief resident, and other dermatologists in the clinic worthy of recognition.

You may also offer comments in support of your dermatologist's PRP savviness.

You may also offer comments regarding your personal reluctance to include your dermatologist in the Registry of PRP-savvy Dermatologists. Negative comments will NEVER be published. But it a be enlightening to know how you think your dermatologist failed.


 

350 characters left.