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发表于 2012-1-11 11:39
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. ~6 p1 ?0 ]2 pPhysician Information
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Female
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5 R6 b9 ~7 @; }3 L. R+ w* @' ]Select One...AfrikaansAlbanianAmharicArabicArmenianAshantiAssyrianBengaliBicolanoBulgarianBurmeseCantonese (China)ChineseCoorgiCreeCroatianCzechDanish (Denmark)DutchEsperanto (International Language)EstonianFarsiFijianFilipino (Philippines)FinnishFlemishFrenchGaelic (United Kingdom)GermanGreekGujarati (India)Gujerati (India)Haitian CreoleHausaHebrewHindiHungarianIboIcelandicIgboIndonesianIrishItalianJapaneseKachiKanarKannadaKhmerKiswahiliKoreanKurdish (Kurmanji / Kurdi)KutchhiLatvianLithuanianMacedonianMalay (Malaysia)Malayalam (India)Maltese/Italian (Malta)Mandarin (China)Marathi (India)Mauritian (Africa)MelanesianNorwegianPakistaniPashtuPersian (Farsi)PolishPortuguesePunjabiPunjabi (India)Romanian/RumanianRussianSaraiki (or Seraiki)SerbianSerbo-CroatianSetswanaShona (Africa)SidhiSign LanguageSindhiSinhalese (Sri Lanka)SiswatiSlovakSlovenianSothoSpanishSwahili (Africa)SwedishTagalog (Philippines)TaiwaneseTamil (India)Telegu (India)Toy-sun-eseTswanaTurkishUkrainianUrdu (Pakistan/India)VietnameseWelshXhosaYiddishYoruba (Africa)Zulu (Africa)" A1 X8 a8 b$ r; Q
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% o Z2 i3 r! I! p First Name (if known): + F1 P/ M j8 Z, K) j& o9 s
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Last Name (if known):
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3 H4 \ H1 \4 P0 M Approval: 7 s0 V! L% F" W3 K6 g7 A
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Select One...AcupunctureAnti-Aging Medicine (Complementary)Ayurveda (Complementary)Bio-Identical Hormone Therapy (Complementary)CCT-Level 2CCT-Level 3Cardiac Nuclear ImagingCardiac Stress TestingCarotid DopplerCertified ExaminerChelation Therapy (Complementary)Chinese Medicine (Complementary)Customized Nutritional Therapy (Complementary)Echocardiography - Full AdultEchocardiography - Full PediatricEchocardiography - RestrictedEchocardiography - TransesophagealElectrocardiogramElectroencephalographyElectromyographyEvoked Potential (EP)Evoked Potential VisualFluoroscopically-guided needle placementsFunctional Medicine (Complementary)Hair TransplantationHerbal Therapy (Complementary)Homeopathy (Complementary)Injury Management ConsultantIntegrative Medical Assessments (Complementary)Longevity Medicine (Complementary)Low Intensity Laser Therapy for the Treatment of Musculoskeletal Disorders (Complementary)Magnetic Resonance - CardiacMagnetic Resonance - FullMagnetic Resonance - LimitedNuclear Medicine - FullNuclear Medicine - LimitedNuclear Medicine - RestrictedOral Chelation Therapy for Autism (Complementary)PET - Positron Emission TomographyPrimordial Sound Meditation (Complementary)Pulm Director - Level IIPulm Director - Level IIIPulm Director - Level IVPulm Interpretation-Level IIPulm Interpretation-Level IIIPulm Interpretation-Level IVRegenerative Medicine (Complementary)Reiki Therapy (Complementary)Resident Approval - Mental Health CertificatesSleep Director - FullSleep Director - Pediatric DisordersSleep Director - Respiratory DisordersSleep Interpreter - Respiratory DisordersThermography to Assess Chronic Pain (Complementary)Transcendental Meditation (Complementary)Transcranial DopplerUltrasound - FullUltrasound - Obstetrical/GynecologyUltrasound - OpthalmologyUltrasound - UrologyUltrasound - VascularVestibular Testing - DirectorVestibular Testing - Interpretor8 l/ |( b( F3 J& H
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Select One...Addiction MedicineAdolescent MedicineAllergiesAllergies - Upper Respiratory TractArthroscopic and Reconstructive Joint SurgeryArthroscopic and Reconstructive Surgery (Knee/Shoulder)Aviation MedicineBreast MedicineBreastfeedingBurn SurgeryCardiac Rhythm Distrubances and Pacemaker TherapyChemical, Biological, Radiological and Nuclear Warfare MedicineChild and Adolescent PsychiatryChild and Maternal HealthChronic Pain ManagementColon & Rectal SurgeryCounselingCritical Care MedicineDermatopathologyDiabetesDiseases of ChildrenDiseases of the EyeDiseases of the JointsDiseases of the KidneyEmergency CareEndocrinologyExercise MedicineForensic PsychiatryForensic Psychiatry & Medico-legal MedicineGeriatric MedicineGeriatric PsychiatryGlaucomaHead and Neck OncologyHead and Neck SurgeryHypnotherapyJoint Replacement & ReconstructionKnee & Leg SurgeryKnee SurgeryLaser SurgeryMaternity Care & Diseases of FemalesMedical GeneticsMental HealthNeonatologyNeuro-ophthalmologyNeuro-otologyNeuroanesthesiaNon-Spine Musculoskeletal ConditionsNutritionNutrition and Weight ManagementObstetrics & GynecologyOccupation Related Medical DisordersOccupational & Aviation MedicineOccupational & Organizational PsychiatryOccupational MedicineOccupational Orthopedics & Clinical ImpairmentOculo-PlasticsOncological Surgery of the Liver and PancreasOrthopedic & Sports Medicine in ChildrenOrthopedic Disability AssessmentOrthopedic TraumatologyPain ManagementPediatric & Adolescent GynecologyPediatric Ophthamology & Adult StrabismusPediatric OrthopedicsPediatric OtolaryngologyPediatric RheumatologyPediatric Sport and Exercise MedicinePerinatologyPhlebologyPhlebology/SclerotherapyPsychiatryPsychological DisordersPsychotherapyPsychotherapy: Individual, Family, & MaritalRepetitive Transcranial Magnetic StimulationReproductive EndocrinologySclerotherapy of Varicose VeinsShoulder SurgerySkin DisordersSleep Disorders MedicineSpeech and Hearing DisordersSport MedicineTravel MedicineUro-oncologyUrogynecology% J& [8 z& ^" x
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