IETF > About the IETF > Forms > Physician Request to be Listed Physician Request to be Listed Click to share on Facebook (Opens in new window)Click to share on Twitter (Opens in new window)Click to share on Google+ (Opens in new window)Click to email this to a friend (Opens in new window)Click to print (Opens in new window) Physician Request to be Listed In order to be listed on the IETF website you will need to submit the form below with your CV attached. Submissions will not automatically be listed. Please allow up to two weeks for approved submissions to be posted. Please note that we do not list neurosurgeons on our website, but instead direct people to the Medtronic website for surgical referrals. Name* First Last Medical Training* MD DO Name of Practice or InstituteAddress*Address 2Address 3City*State/Province*Zip/Postal Code*Country*Email*WebsiteAppointment Phone*FaxBoard Certified? Yes No Fellowship in Movement Disorders? Yes No Specialty: Adult Pediatrics Memberships: AMA ANA AAN MDS Other OtherPlease list your other membershipsOffice Services: Botox DBS Programming Other Other Office Services:Please only note other services that are meaningful to your essential tremor patients.Share additional information about your request:Please upload a copy of your CV for review. Only requests that are accompanied by a CV will be considered for listing.*Word document or PDFCaptcha: For our security and for yours.PhoneThis field is for validation purposes and should be left unchanged.