Become a Patient-Teacher

Please fill out and submit the following information if interested in becoming a Patient-Teacher. Please remember to send us a signed Consent form that you can access from this page. We will be in touch over the next few days to discuss details. On behalf of educators and members of the medical field, thank you for providing your powerful and unique perspective.

Patient Required

Metabolic diagnosis Required

Secondary Metabolic Diagnosis

Speaker Required

Relationship to Patient Required

Address Required

Email Required

Phone Required

Public Speaking Experience Required

Speaker bureau Required

Story recorded before Required

Can Your Story Be Recorded? Required

Photos/videos in future recordings Required

Drive less than 2 hrs Required

Drive more than 2 hrs Required

Travel by plane train Required

Other Info

Consent Required

Click here for the Consent form to sign and return.

Thank you for your interest in this service. The Patient-Teacher Registry is maintained by generous donations and grants from supporters. You may wish to make a donation through our Contributions page, or please let us know if you believe your institution would be interested in becoming a supporter of this service.