Health Professionals – You are invited to provide the following information to register or update an entry on the BTAA register of people with a professed interest in the management of brain tumours, published on the treatment options page on www.btaa.org.au

This form gathers information to enhance the directory of medical professionals with a professed interest in brain tumours in Australia currently available on http://www.btaa.org.au The list is intended to be an initial reference point for patients and their families. It is not an endorsement of any particular medical professional or centre. If you have any queries please contact BTAA on Freecall 1800 857 221

Please complete this and return to secretary@btaa.org.au or mail to BTAA, PO Box 76 Dickson ACT 2602.

Please advise (secretary@btaa.org.au) of updates of your details on the directory as required.

1. Name of medical practitioner/specialist

2. Nature of interest or specialty

Y N Neurosurgeon,

Y N Medical oncologist

Y N Radiation oncologist

Y N Other (please specify)

3. Name of centre/s where you consult and provide services (including street address)

4. Practice address/es for referrals and phone numbers for appointments

5. Do you have a particular interest in

Y N A particular type(s) of tumour

Y N A particular region of the central nervous system

Y N A particular stage of malignancy

Y N A particular age group e.g. paediatric services, metastatic brain tumours

If yes to any of the above, please describe your area(s) of specialisation (over)

6. Do you work:

Y N in the public system?

Y N in the private system?

Y N both?

7. Do you provide second opinions to interested persons (assuming they provide the appropriate referrals?

Y N

8. Would you like to add any other relevant information about your services? E.g. multidisciplinary care, involvement in clinical trials.

Please complete this form and email to secretary@btaa.org.au or mail to BTAA, PO Box 76 Dickson ACT 2602. Please update your information on the directory as required.