EpiCARE Centers Update of Individual Information

Disseminate to all Individual healthcare providers of your team, independently of their speciality.

Individual Members EpiCARE (Full & Affiliated & Supporting Centres)

With this questionnaire we aim to get a more accurate picture of the individual expertise of all healthcare providers (Doctors; Researchers; Nurses; EEG Technicians; Neuropsychologists; Neurosurgeons etc.) and other staff of the ERN EpiCARE teams (Full and Affiliated accredited centres; Supporting Medical teams).

The personal data collected from healthcare professionals (full name, organization, email address and country) will be treated confidentially. The Coordination Office takes all appropriate technical and organizational measures in order to comply with the applicable data protection laws, including the General Data Protection Regulation (EU) 2016/679 as from 25 May 2018, and ensures the protection of the rights of healthcare professionals as data subjects. The questionnaire is also subject to SurveyMonkey’s (or OTHER) Terms of Use, including its Privacy Policy.

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* 1. LAST NAME

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* 2. FIRST NAME(S)

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* 3. What is your contact email address?

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* 4. Other email address you would like to add (for example, your secreatry´s, a second email you are using, etc)

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* 5. Name of Institution you are working for

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* 6. Is your Hospital ...?

Adult HCP only

Pediatric HCP only

Both

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* 7. Which is YOUR main field of expertise (one possible answer, so please choose the one that best represents your field of competence, other competences can be chosen in the next question).

Adult Neurologist

Child Neurologist

Neonatologist

Neurophysiologist

Neuroradiologist

Functional Neuroimaging

Neuropathologist

Geneticist

Stereo-EEG Expert

Neurosurgeon

Functional Neurosurgeon

Neuropsychologist

Neurorehabilitation

Neurometabolic Diseases

Psychiatrist

Psychologist

Dietician

Sleep Disorders

Physician in Training

Nurse

EEG Technician

Research (Clinical)

Research (Fundamental)

Clinical Research Assistant

Other (please specify)

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* 8. Your other fields of expertise (please do NOT select again the main one, selected in the previous question)

Adult Neurologist

Child Neurologist

Neonatologist (Neonatal Epilepsies)

Neurophysiologist

Neuroradiologist

Functional Neuroimaging

Neuropathologist

Geneticist

Stereo-EEG Expert

Neurosurgeon

Functional Neurosurgeon

Neuropsychologist

Neurorehabilitation

Neurometabolic Diseases

Psychiatrist

Psychologist

Dietician

Sleep Disorders

Physician in Training

Nurse

EEG Technician

Research (Clinical)

Research (Fundamental)

Only my main field of competences (previous question)

Other (please specify)

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* 9. Information about your interest to participate in EpiCARE Working Groups (several answers possible)

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* 10. I would like to receive information about...

	Yes	No
EpiCARE Newsletter (monthly)	EpiCARE Newsletter (monthly) Yes	EpiCARE Newsletter (monthly) No
Research Council & Calls Newsletter	Research Council & Calls Newsletter Yes	Research Council & Calls Newsletter No
Webinars & Educational Activities	Webinars & Educational Activities Yes	Webinars & Educational Activities No
Case Discussions - Non Surgical	Case Discussions - Non Surgical Yes	Case Discussions - Non Surgical No
Case Discussions -Surgical	Case Discussions -Surgical Yes	Case Discussions -Surgical No

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* 11. Please feel free to add any relevant comments or questions in the following comment box

We thank you for your kind cooperation and help in filling out this questionnaire !
We appreciate your valuable input in order to collect all relevant information regarding our network.

Prof. Alexis Arzimanoglou and the Project Managers team

	Already Member	Would like to join	Not interested
WG2 -Clinical Genetics & Orphacodes	WG2 -Clinical Genetics & Orphacodes Already Member	WG2 -Clinical Genetics & Orphacodes Would like to join	WG2 -Clinical Genetics & Orphacodes Not interested
WG3 - Neuroimaging	WG3 - Neuroimaging Already Member	WG3 - Neuroimaging Would like to join	WG3 - Neuroimaging Not interested
WG4 - Neurophysiology	WG4 - Neurophysiology Already Member	WG4 - Neurophysiology Would like to join	WG4 - Neurophysiology Not interested
WG5 - Neuropsychology - Adults	WG5 - Neuropsychology - Adults Already Member	WG5 - Neuropsychology - Adults Would like to join	WG5 - Neuropsychology - Adults Not interested
WG5 - Neuropsychology - Children	WG5 - Neuropsychology - Children Already Member	WG5 - Neuropsychology - Children Would like to join	WG5 - Neuropsychology - Children Not interested
WG6 - Neuropathology	WG6 - Neuropathology Already Member	WG6 - Neuropathology Would like to join	WG6 - Neuropathology Not interested
WG7 - Targeted Medical Therapies & Clinical Trials (global)	WG7 - Targeted Medical Therapies & Clinical Trials (global) Already Member	WG7 - Targeted Medical Therapies & Clinical Trials (global) Would like to join	WG7 - Targeted Medical Therapies & Clinical Trials (global) Not interested
WG7 - Special Interest Group on (N-of-1) trials for precision treatment of genetic epilepsies	WG7 - Special Interest Group on (N-of-1) trials for precision treatment of genetic epilepsies Already Member	WG7 - Special Interest Group on (N-of-1) trials for precision treatment of genetic epilepsies Would like to join	WG7 - Special Interest Group on (N-of-1) trials for precision treatment of genetic epilepsies Not interested
WG7 - Special Interest Group on Autoimmune diseases with epilepsy as a core symptom	WG7 - Special Interest Group on Autoimmune diseases with epilepsy as a core symptom Already Member	WG7 - Special Interest Group on Autoimmune diseases with epilepsy as a core symptom Would like to join	WG7 - Special Interest Group on Autoimmune diseases with epilepsy as a core symptom Not interested
WG7 - Special Interest Group on Methodology for trials including Patient centered outcomes (PICOMs)	WG7 - Special Interest Group on Methodology for trials including Patient centered outcomes (PICOMs) Already Member	WG7 - Special Interest Group on Methodology for trials including Patient centered outcomes (PICOMs) Would like to join	WG7 - Special Interest Group on Methodology for trials including Patient centered outcomes (PICOMs) Not interested
WG7 - Special Interest Group on treatment of Tuberous Sclerosis	WG7 - Special Interest Group on treatment of Tuberous Sclerosis Already Member	WG7 - Special Interest Group on treatment of Tuberous Sclerosis Would like to join	WG7 - Special Interest Group on treatment of Tuberous Sclerosis Not interested
WG7 - Special Interest Group on non-medical interventions in epilepsy	WG7 - Special Interest Group on non-medical interventions in epilepsy Already Member	WG7 - Special Interest Group on non-medical interventions in epilepsy Would like to join	WG7 - Special Interest Group on non-medical interventions in epilepsy Not interested
WG7 - Special Interest Group on Ketogenic Diet treatments	WG7 - Special Interest Group on Ketogenic Diet treatments Already Member	WG7 - Special Interest Group on Ketogenic Diet treatments Would like to join	WG7 - Special Interest Group on Ketogenic Diet treatments Not interested
WG8 - Pre-surgical evaluation and/or Epilepsy Surgery	WG8 - Pre-surgical evaluation and/or Epilepsy Surgery Already Member	WG8 - Pre-surgical evaluation and/or Epilepsy Surgery Would like to join	WG8 - Pre-surgical evaluation and/or Epilepsy Surgery Not interested
WG9 - Neonatal seizures and epilepsies	WG9 - Neonatal seizures and epilepsies Already Member	WG9 - Neonatal seizures and epilepsies Would like to join	WG9 - Neonatal seizures and epilepsies Not interested
WG10 - Development of National Reference Networks & Public Health Policies in Epilepsy care	WG10 - Development of National Reference Networks & Public Health Policies in Epilepsy care Already Member	WG10 - Development of National Reference Networks & Public Health Policies in Epilepsy care Would like to join	WG10 - Development of National Reference Networks & Public Health Policies in Epilepsy care Not interested
WG13 - Guidelines	WG13 - Guidelines Already Member	WG13 - Guidelines Would like to join	WG13 - Guidelines Not interested
WG14 - Education & Training	WG14 - Education & Training Already Member	WG14 - Education & Training Would like to join	WG14 - Education & Training Not interested
WG16 - Genetic Research	WG16 - Genetic Research Already Member	WG16 - Genetic Research Would like to join	WG16 - Genetic Research Not interested
WG17 - Dissemination policies	WG17 - Dissemination policies Already Member	WG17 - Dissemination policies Would like to join	WG17 - Dissemination policies Not interested
WG18 - Epilepsy Beyond Seizures - Adults	WG18 - Epilepsy Beyond Seizures - Adults Already Member	WG18 - Epilepsy Beyond Seizures - Adults Would like to join	WG18 - Epilepsy Beyond Seizures - Adults Not interested
WG18 - Epilepsy Beyond Seizures -SIG on Transition	WG18 - Epilepsy Beyond Seizures -SIG on Transition Already Member	WG18 - Epilepsy Beyond Seizures -SIG on Transition Would like to join	WG18 - Epilepsy Beyond Seizures -SIG on Transition Not interested
WG18 - Epilepsy Beyond Seizures - Pediatric	WG18 - Epilepsy Beyond Seizures - Pediatric Already Member	WG18 - Epilepsy Beyond Seizures - Pediatric Would like to join	WG18 - Epilepsy Beyond Seizures - Pediatric Not interested
WG19 - ePAG -Patient Advocates Group	WG19 - ePAG -Patient Advocates Group Already Member	WG19 - ePAG -Patient Advocates Group Would like to join	WG19 - ePAG -Patient Advocates Group Not interested
WG20 - Nurses & EEG Technicians	WG20 - Nurses & EEG Technicians Already Member	WG20 - Nurses & EEG Technicians Would like to join	WG20 - Nurses & EEG Technicians Not interested

EpiCARE Centers Update of Individual InformationDisseminate to all Individual healthcare providers of your team, independently of their speciality.

Individual Members EpiCARE (Full & Affiliated & Supporting Centres)

Question Title

* 1. LAST NAME

Question Title

* 2. FIRST NAME(S)

Question Title

* 3. What is your contact email address?

Question Title

* 4. Other email address you would like to add (for example, your secreatry´s, a second email you are using, etc)

Question Title

* 5. Name of Institution you are working for

Question Title

* 6. Is your Hospital ...?

Question Title

* 7. Which is YOUR main field of expertise (one possible answer, so please choose the one that best represents your field of competence, other competences can be chosen in the next question).

Question Title

* 8. Your other fields of expertise (please do NOT select again the main one, selected in the previous question)

Question Title

* 9. Information about your interest to participate in EpiCARE Working Groups (several answers possible)

Question Title

* 10. I would like to receive information about...

Question Title

* 11. Please feel free to add any relevant comments or questions in the following comment box

EpiCARE Centers Update of Individual Information

Disseminate to all Individual healthcare providers of your team, independently of their speciality.