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Provider Directory Submission Form

The Lipedema Foundation is establishing an online Provider Directory to help Lipedema patients and the broader Lipedema community identify healthcare providers who diagnose Lipedema in their clinical practice. Our goal is to empower Lipedema patients and their caregivers to make informed decisions regarding their providers.

If you are a clinician who can diagnose Lipedema and would like to be included in the Provider Directory, please complete the form below. We will review the information you provide, and if you meet our inclusion criteria, we will list you in the Directory. Please note that we reserve the right to remove your listing at our discretion. By submitting your information in the form below, you accept these terms and waive any right to object to either to our listing or removal of your listing in the Provider Directory.

At this time, the Provider Directory will not include providers who perform invasive procedures (e.g., liposuction, vein ablation) for people with Lipedema. Providers who do not themselves perform invasive procedures, but who collaborate closely in the same practice with others who do perform invasive procedures, may be included in the Directory on a case-by-case basis, at the discretion of LF.

In the future, we may expand the Directory to include clinicians who perform invasive procedures. If you are a clinician who performs invasive procedures and would like us to contact you if we expand in the future, please complete and submit this form.
Each entry to the directory must be a unique email address; the same email address cannot be used more than once. NOTE: Your personal email will NOT be listed publicly.
Clinic, hospital, or company name where you practice
The city where your practice is located
The postal code of your practice
xxx-xxx-xxxx
Please check all credentials that apply.*
Please check all practice areas that apply.*

Diagnosis

I am comfortable educating the patient on and offering medical management strategies, including:*
Select all that apply.
I am comfortable making referrals to other specialties for continued care, including:*
Select all that apply.

Treatments

Which of these treatments do you personally provide for patients with Lipedema? Select all that apply.*
Which of these treatments do others in your practice provide for patients with Lipedema? Select all that apply.*
Do you have a team of people you work with or can typically refer Lipedema patients to when necessary?*

The next few questions are for internal use only and are completely optional. We appreciate your answers.

Which of the following diagnosis codes do you use for Lipedema?
Are you interested in being considered by LF for participation in opportunities to help educate others about Lipedema?

Consent and Submit

 

By clicking Submit below, you understand and acknowledge that the Lipedema Foundation will treat the information provided by you via the forms above in accordance with its Privacy Policy, which you have read and acknowledged. The LF Privacy Policy can be found at www.lipedema.org/privacy-policy. Additionally, you agree to the Lipedema Foundation contacting you about the Provider Directory and other professional education, research, and related activities.