MSU - Myositis Physicians Enter your physicians information We are putting together a database of physicians who treat myositis. Your input is greatly appreciated. OK Question Title * 1. Name of Doctor OK Question Title * 2. Speciality Neurology Neuromuscular Specialist Rheumatology Dermatology Pulmonology Rehabilitation Specialist Other (please specify) OK Question Title * 3. For which form of myositis does this doctor treat you? Dermatomyositis (DM) Polymyositis (PM) Inclusion Body Myositis (IBM) Juvenile PM/DM Necrotizing Autoimmune Myopathy (NAM) Orbital Myositis (OM) Antisynthetase Syndrome (ASS) Mixed Connective Tissue Disease (MCTD) Other (please specify) OK Question Title * 4. How you would rank this doctor in terms of knowledge/experience with your disease? Poor Not good Average Good Great Poor Not good Average Good Great OK Question Title * 5. How you would rank this doctor in terms of listening to your needs? Poor Not good Average Good Great Poor Not good Average Good Great Other (please specify) OK Question Title * 6. Physicians Contact Information (Input as many as possible, esp State) Name University/Practice Name Address Address 2 City/Town State/Province -- select state -- AL AlabamaAK AlaskaAS American SamoaAZ ArizonaAR ArkansasCA CaliforniaCO ColoradoCT ConnecticutDE DelawareDC District of ColumbiaFM Federated States of MicronesiaFL FloridaGA GeorgiaGU GuamHI HawaiiID IdahoIL IllinoisIN IndianaIA IowaKS KansasKY KentuckyLA LouisianaME MaineMH Marshall IslandsMD MarylandMA MassachusettsMI MichiganMN MinnesotaMS MississippiMO MissouriMT MontanaNE NebraskaNV NevadaNH New HampshireNJ New JerseyNM New MexicoNY New YorkNC North CarolinaND North DakotaMP Northern Mariana IslandsOH OhioOK OklahomaOR OregonPW PalauPA PennsylvaniaPR Puerto RicoRI Rhode IslandSC South CarolinaSD South DakotaTN TennesseeTX TexasUT UtahVT VermontVI Virgin IslandsVA VirginiaWA WashingtonWV West VirginiaWI WisconsinWY Wyoming ZIP/Postal Code Country Email Address Phone Number OK Question Title * 7. Physicians website OK Question Title * 8. Add any additional notes about the physician you are listing OK Question Title * 9. Add any other notes to help us with our listing or add another physician here OK Question Title * 10. Your contact information (optional) Name City/Town State/Province -- select state -- AL AlabamaAK AlaskaAS American SamoaAZ ArizonaAR ArkansasCA CaliforniaCO ColoradoCT ConnecticutDE DelawareDC District of ColumbiaFM Federated States of MicronesiaFL FloridaGA GeorgiaGU GuamHI HawaiiID IdahoIL IllinoisIN IndianaIA IowaKS KansasKY KentuckyLA LouisianaME MaineMH Marshall IslandsMD MarylandMA MassachusettsMI MichiganMN MinnesotaMS MississippiMO MissouriMT MontanaNE NebraskaNV NevadaNH New HampshireNJ New JerseyNM New MexicoNY New YorkNC North CarolinaND North DakotaMP Northern Mariana IslandsOH OhioOK OklahomaOR OregonPW PalauPA PennsylvaniaPR Puerto RicoRI Rhode IslandSC South CarolinaSD South DakotaTN TennesseeTX TexasUT UtahVT VermontVI Virgin IslandsVA VirginiaWA WashingtonWV West VirginiaWI WisconsinWY Wyoming ZIP/Postal Code Country Email Address Phone Number OK COMPLETE