ISEAI Diplomate Membership

All information is required for those who want to be on our referral list. We never share a member’s private information so, for communication purposes, we would appreciate it if you share all contact information requested.

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Price:

$300 for 1 Year

First Name:* First Name Required

Last Name:* Last Name Required

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City:* City is Required

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State/Province:* State/Province is Required

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Personal Phone:* Personal Phone is Required

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Office Phone (for directory listing, if applicable):* Office Phone (for directory listing, if applicable) is Required

Office Email (for directory listing, if applicable):* Office Email (for directory listing, if applicable) is Required

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Accepts Insurance Accepts Medicare Accepts Medicaid Superbill Only Consultations Online Consultations by Phone

Highest level of education:* Highest level of education is Required

Are you actively practicing in the field of environmentally acquired illness (EAI)? If yes, for how long?:* Are you actively practicing in the field of environmentally acquired illness (EAI)? If yes, for how long? is Required

Please list any EAI-related training or certification: ADAPT (Kresser), Bredesen, CIRS, IFM, ILADEF/ILADS, etc - provide specifics if needed:* Please list any EAI-related training or certification: ADAPT (Kresser), Bredesen, CIRS, IFM, ILADEF/ILADS, etc - provide specifics if needed is Required

In addition to above, who are the most influential teacher(s) or institution(s) you have been affiliated with in the EAI field? Please tell us about your association with them.:* In addition to above, who are the most influential teacher(s) or institution(s) you have been affiliated with in the EAI field? Please tell us about your association with them. is Required

Please provide any other information about your professional experience in the EAI field, personal interests in EAI (if any), and any other background information you wish to share:* Please provide any other information about your professional experience in the EAI field, personal interests in EAI (if any), and any other background information you wish to share is Required

Please provide any information about your interest in environmentally acquired illness and/or any other background information you wish to share: Please provide any information about your interest in environmentally acquired illness and/or any other background information you wish to share is not valid

Do you currently carry prescriptive rights in the state/territory you actively practice in?: Do you currently carry prescriptive rights in the state/territory you actively practice in? is not valid

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General educational/professional experience:* General educational/professional experience is Required

Other areas of special interest/expertise:* Other areas of special interest/expertise is Required

Statement of medical or health professional board action(s): Statement of medical or health professional board action(s) is not valid

Malpractice history: Malpractice history is not valid

Willingness to participate on committees or projects set up by the Board:* Willingness to participate on committees or projects set up by the Board is Required

Inclusion on internal referral list?:* Inclusion on internal referral list? is Required

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Is there someone we can thank for your referral? Are they an ISEAI Member?: Is there someone we can thank for your referral? Are they an ISEAI Member? is not valid

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Diplomate

ISEAI Diplomate Membership

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Diplomate

ISEAI Diplomate Membership

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About the Author: ISEAI Admin