Register Host Center

Please complete this application to be included in this exciting program as a participating center. All arrangements are to be facilitated directly by the visiting international therapist and the participating center. There is no financial funding for this program by IFSHT or by the participating center.
When you finish registering your facility, your information will be forwarded to IFSHT for a brief review. If there are no questions, your information will be posted on our website. If your clinic is posted, you will be asked to review and update your information at least once a year.

Username: *

Spaces are allowed; punctuation is not allowed except for periods, hyphens, and underscores.

E-mail address: *

A valid e-mail address. All e-mails from the system will be sent to this address. The e-mail address is not made public and will only be used if you wish to receive a new password or wish to receive certain news or notifications by e-mail.

Name of clinic: *

Host center information

Spoken languages: *

Web site:

Specializations:

Amputations

Burns

Chronic pain syndrome

Fractures and dislocations

Nerve compression

Nerve injuries

Pediatrics

Prosthetics

Rheumatic disease

RSD

Tendon injuries

Trauma

Contact

Country: *

City: *

State:

Postal address: *

Postal code:

Telephone:

Fax:

Contact person: *

Email:

Enter an email that will be displayed to the public.

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