Provider Directory Submission Form

The Lipedema Foundation Provider Directory aims to help patients and the wider community identify therapists who treat Lipedema. Our goal is to empower Lipedema patients and their caregivers to make informed decisions about their providers.

If you are a therapist who treats 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.

We plan to include additional specialties in the Provider Directory. We are starting with therapists since they are one of the few clinical specialties offered Lipedema-specific training and they play a central role in the care ecosystem. If you are not a therapist but would like to be included in our Provider Directory, please sign up for our monthly newsletter instead of filling out this form to learn when we expand!

Personal email address*

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.

First name*

Last name*

Affiliated Organization*

Clinic, hospital, or company name where you practice

City*

The city where your practice is located

Postal code*

The postal code of your practice

State*

CLT program

If you are a CLT, through which program did you receive your certification?

State of Licensure*

License Number*

Do you currently treat Lipedema patients?*

What phone number should patients use to schedule an appointment?*

xxx-xxx-xxxx

What website should patients use to schedule an appointment?

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

How did you become involved with or familiar with Lipedema?

How did you hear about the LF Provider Directory?

What do you think LF could do to increase awareness of Lipedema within your professional sphere/field?

Do you have a team of people you work with or can typically refer Lipedema patients to when necessary?

Yes

Are you interested in being considered by LF for participation in opportunities to help educate others about Lipedema?

Yes

Provider Directory Submission Form

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

Consent and Submit