Specialist Questionnaire

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Specialist Submission

Practice info
Name*
Prefix First Middle Initial Last Suffix
Degree*
Specialty*
Title
Division
Department*
Institution*
Mailing address 1*
Mailing address 2
City*
State*
Country*
Zip*
Patient scheduling telephone*
Which category best describes your practice?*
URL to your online clinical biography*
Upload a professional photo for your bio
Accepted file types: jpg, png, gif, Max. file size: 5 MB.
Describe your NETs experience
The answers to the following questions will be populated in your biography to help users gain a sense of your neuroendocrine tumor experience.
NETs clinical care
Roughly what percentage of your practice is made up of neuroendocrine cancer patients?*
For how many years (including training/fellowships) have you provided clinical care to patients diagnosed with NETs.
Please enter a number from 1 to 90.
Please indicate subspecialty areas in which you have conducted research, received training, or otherwise devoted time to advance your skills.
- Lung NETs
- GI NETs
- Pancreatic NETs
- Pheochromocytoma/Paraganglioma
- Liver metastasis
- Nuclear medicine
- Complementary/Integrative Medicine
- Pediatric/Young adult
- Palliative care
- Nutrition
- Transplant
Other subspecialty area
NETs Research
Are you currently involved in neuroendocrine cancer research?*
- Yes
- No
List any specific NET research interests.
In how many NET-related published peer-reviewed journal articles are you listed as author or co-author?
Please enter a number from 0 to 900.
Please indicate any active memberships in NET-related professional associations.
- North American Neuroendocrine Tumor Society (NANETS)
- European Neuroendocrine Tumor Society (ENETS)
- Society of Nuclear Medicine and Molecular Imaging (SNMMI)
- American Association of Cancer Research (AACR)
- NCCN NET Guidelines Panel Member
Other active memberships
Please indicate any professional associations in which you currently play a leadership role (officer, board member, advisory board member, editor, committee chair, etc.).
- North American Neuroendocrine Tumor Society (NANETS)
- European Neuroendocrine Tumor Society (ENETS)
- Society of Nuclear Medicine and Molecular Imaging (SNMMI)
- American Association of Cancer Research (AACR)
- NCCN Guidelines Panel Member
Other professional associations in which you currently play a leadership role.
Contact info for your bio
Please complete the following so we may can annually update your biography for accuracy. This information will not be published in your online biography. NETRF will use it to keep your information up to date.
Your office telephone
(unpublished, used to keep your profile current)
Your office email

(unpublished, used to keep your profile current)
Please send me NETRF research grant announcement and invitations to NET research symposia.
- Yes, please.
Administrative Assistant
First Last
Administrative Assistant Telephone
Administrative Assistant Email
Thank you for taking time to submit your clinical biography. If you have any questions about your biography, please email us at info@netrf.org.

By completing this form on our website, you give your consent that your information will be used in the ways described in NETRF's privacy policy.
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- Agree
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