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Healthcare Professional Contact



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I am*:
New to IDF  Updating existing information
I am*:  (check all that apply)
Physician Nurse Other: 
Contact Information:

Please indicate your specialty (select any that apply)*:

Allergy Immunology
Chest Medicine Infectious Disease
ENT Internal Medicine
Family Practice Pediatrics
Hematology Rheumatology
None of These or Other:

Do you follow any patients with a Primary Immunodeficiency Disease (PIDD)?*

Yes No

How many patients do you follow that have a PIDD?*
(Enter 0 if you have not yet treated a patient with a PIDD)

  Patients

Do you treat or manage patients with immunoglobulin therapy?*

Yes No

Please tell us about the PIDD patients you follow:

Do you follow any patient with any of the following diagnoses?
(check all that apply)
Please indicate whether the patients with the corresponding diagnosis are adults or children.
(check all that apply)
Adult Pediatric
Adult Pediatric
Adult Pediatric
Adult Pediatric
Adult Pediatric
Adult Pediatric
Adult Pediatric
Adult Pediatric
Adult Pediatric
Adult Pediatric
Adult Pediatric
Adult Pediatric
Adult Pediatric
Adult Pediatric

 

How did you hear about IDF? (Select one)

Internet Newspaper Article/News Story
Healthcare Professional Company providing a product or service to the PIDD Community
Other Patient/Family Member Other
IDF Materials
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If you currently manage patients with a Primary Immunodeficiency Disease, IDF encourages you to please take a moment to read about the United States Immunodeficiency Network (USIDNET)
Working under a grant from The National Institutes of Health and National Institute of Allergy and Infectious Diseases (NIH/NIAID), the United States Immunodeficiency Network (USIDNET) is developing a national registry of patients with primary immunodeficiency diseases for the purposes of:

  • Providing a minimum estimate of the prevalence of each disorder in the United States
  • Promoting collaborative research
  • Learning more about phenotypic variations
  • Determining the natural history of these genetic disorders
  • Providing a comprehensive clinical picture of each disorder
  • Learning the effects of treatment protocols
  • Evaluating quality of life measures in this patient population
  • Providing a resource for clinical and laboratory research

If you would like to learn more about the Registry, please visit www.usidnet.org.