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Parkinson’s Disease Research, Education and Clinical Centers

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Membership and Consortium Center Designation

MEMBERSHIP INFORMATION


 

General Membership

All clinicians employed by the Department of Veterans Affairs who serve veterans with Parkinson's disease and related disorders (regardless of capacity) are invited and encouraged to register as a member of the National VA Parkinson’s Disease Consortium. Membership is free and grants access to a variety of Parkinson’s disease resources. General membership does not require participation as a Consortium Center. You can register today by completing and forwarding the application below.

Consortium Center Designation

Consortium Center designations are dependent on several factors, the most important being the interest and availability of the Consortium member. Other factors of consideration include the extent of movement disorder experience and current practice, support from the local VA administration, and the geographic needs of the Consortium Network. Interested members are encouraged to contact the Consortium Coordinating Center to discuss this opportunity. Additionally, the Consortium Executive Committee will independently extend invitations based on the needs of the Consortium Network.


Applications should be printed then faxed or mailed to:

Dawn McHale
Administrative Officer / National Coordinator
PADRECC / VA Parkinson's Disease Consortium
Philadelphia VA Medical Center
University and Woodland Avenues #127
Philadelphia, PA 19104
(w) 215-823-5800 ext. 2238 (f) 215-823-4603

dawn.mchale@va.gov



1. Last Name:

2. First Name:

3. Middle Initial:

4. Credentials:

5. Name of VAMC:

6. Mailing Address:
 

7. City:

8. State:

9. Zip:

10. Phone (include area code):

11. Fax:

12. Email:

13. Your title:

14. Do you currently treat patients with Parkison's Disease or related movement disorder:
Yes
No

a. If yes, how many?

b. If no, to whom do your refer them to?

15. Do you have specialized training in the treatment of Parkinson's disease and related movement disorders? If yes, Please explain.
 

16. Are you active in any national or local organizations focused on Parkinson's disease or related movement disorders? If yes, please list the organizations and/or groups.
 

17. Are you currently involved with any type of support or research programs for those with Parkinson's disease and related movement disorders? If so, please explain.
 

18. Why are you interested in becoming a member of the National VA Parkinson's Disease Consortium?
 

History & Mission /  Consortium Center Refferal List /  Movement Disorder Series / Resource Request Form / Grant Opportunities /  Education & Clinical Resources / The Monthly Transmitter / Consortium Newsletters / Consortium Brochures