NOTE: Due to a recent upgrade some of the search features are not included on the page. We are working to fix this and expect a solution this week. Thank you for your patience.
PHYSICIANS: If you are submitting this form from a physician's office, we will contact you to confirm receipt and go over any questions you may have. DINET MEMBERS: If you are a DINET member submitting this form, please understand that inclusion is not guaranteed. We will contact the physician for their permission to be included on our site. If you do not know all of the information requested, we will retrieve what we need when we speak to their office. Please be sure to give us the physician's correct contact information so that we can reach them without delay. Thank you.