Clinical Consult Program

The Clinical Consult Program will provide a one-on-one forum in which a preceptor (a specialist in treating spasticity, muscle overactivity, and spastic paresis) can mentor a participating physician (a practicing neurologist or physiatrist who is interested in improving their spasticity-management skills). In a ¾-day program, the preceptor will review patients with spasticity or other conditions that result from upper motor neuron syndrome with the participating physician at the preceptor's office, clinic, or institution. Participating physicians will complete a Preprogram Questionnaire, which will be shared with the preceptor before the Clinical Consult, and a Postprogram Questionnaire about 1 month after, to measure the effectiveness of this CME program. Preceptors will host a Clinical Consult at their office. They will be responsible for scheduling 2 to 5 patients with spasticity and completing a Patient Qualification and Selection Checklist for each; the checklists will be sent to the preceptor to review before the Clinical Consult. The goal of the Clinical Consult Program is to increase participating physicians' skills with differential diagnosis, identifying appropriate treatment options, setting goals, and reviewing protocols for various pharmacologic therapies.

For more detailed information and answers to frequently asked questions, please click here.

If you would like to be mentored by a preceptor in the Clinical Consult Program, please complete the Clinical Consult Request form below.

* indicates a required field.

Clinical Consult Request

*First name:

*Last name:

MI:

Years in practice:

*Degree:

Title:

Specialty:

*Affiliation:

Hospital-based

University-based

Private practice

Clinic

Other (Please specify)

*Address:

Address 2:

*City:

*State: AK AL AR AZ CA CO CT DC DE FL GA HI IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA RI SC SD TN TX UT VA VT WA WI WV WY

*ZIP:

*Phone: (used as secondary form of contact) (eg, xxx-xxx-xxxx)

Ext:

Fax:

*E-mail: This e-mail address will be used as primary contact for scheduling.

Best time to contact:

Administrative assistant name:

Admin Office phone: (eg, xxx-xxx-xxxx)

Ext:

Admin Fax:

Admin E-mail:* This e-mail address will be used as primary contact for scheduling.

Admin Best time to contact:

Because you have attended or shown interest in our programs, we may send you information on this and similar programs utilizing the e-mail address provided. You may unsubscribe at any time by clicking on the "unsubscribe" link on any e-mails sent from us.

Please do not send me information via e-mail.

*Please indicate how far you are willing to travel to a preceptor's office for the Clinical Consult.

Does your office have the necessary tools to treat patients with spasticity using chemodenervation therapy,^a if applicable?

Yes

No

What is your comfort level with therapeutic injections?

Very comfortable

Somewhat comfortable

Not comfortable

Briefly describe your experience in the diagnosis and management of spasticity and other muscle overactivity conditions and your exposure to and aptitude in various treatment modalities, including chemodenervation agents. Explain your interest and desire in improving your spasticity management skills.

How did you hear about this program?

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Because of the educational nature of this program, treatment costs will not be reimbursed. Any patient scheduled for the NeuroRehab Clinical Consult Program who requires treatment should be billed as they would for a regularly scheduled visit, eg, through insurance.

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