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Terri's Life & Hope Physician & Attorney Network

Terri's Life & Hope Physician & Attorney Network

Please fill out the fields below. After you complete and submit your information, the Terri Schiavo Life & Hope Network will maintain your information on an ongoing basis and it will not be made public.

First Name

Last Name

Address

City

State

Zip

Telephone Number (Office)

Telephone Number (Cell)

Profession (Check All That Apply)

Attorney
Medical Doctor
Registered Nurse
Nurse Practitoner
Physicians Assistant
Social Worker
Administrator
Psychiatrist
Psychologist

Specialty

States in which licensed to practice

Hospital with which associated (physicians)

Willing to review medical records in selected cases to give professional opinion on need for and likely efficacy of life-preserving treatment, nutrition or hydration?

Willing to consider, when authorized, conducting an independent medical examination in order to give such an opinion?

Willing to consider accepting transfer of a patient who is being denied life-preserving treatment, nutrition or hydration?

Willing to talk to a patient or patient advocate who is faced with a life threatening situation?

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Terri's Story
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Terri Schiavo Life & Hope Network
P.O. Box 521 / Narberth, PA 19072
1.855.300.HOPE (4673) / www.lifeandhope.com / Email Main Office

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