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Add A Treatment Center

Please fill out the following form with as much accuracy as possible.

Please note that although you are being asked for your email, this information will not be posted on the website.  It is solely for NBTS contact purposes and will not be shared with any other third parties.

Name of Treatment Center:
Clinical Coordinator/Contact Name:

 Neurosurgeons and/or Neuro-oncologists at this center (please include first name, last name and credentials):
Doctors Name Neurosurgeon Neurooncologist 
Address 1:
 Address 2:
City:
 State:
Zip:
 		E-Mail:
Phone:
 Fax:
Website:


Approximately how many brain tumor surgeries are performed at your facility annually (Please note that "surgery" does NOT include stereotactic radiosurgery, such as Gamma Knife, Cyberknife, Novalis, etc)

 

What type of intraoperative technolgies does your treatment center use? (Check all that apply)

 

Approximately how many brain tumor patients receive radiation therapy from your facility per year (Please note that "surgery" does NOT include stereotactic radiosurgery, such as Gamma Knife, Cyberknife, Novalis, etc)?

 

 

What type of stereotactic radiosurgery technologies does your treatment center use? (Check all that apply)

 

 

Approximately how many brain tumor patients receive stereotactic radiosurgery from your facility per year?

 

 

Is there a brain tumor board system in place at your facility?

 

If Yes, what disciplines attend tumor board meetings? (Check all that apply)

 

 

Do you collaborate with cooperative research group protocols (i.e. RTOG, COG, NABTC, NABTT)?

 

If Yes, which ones?



Is there an existing brain tumor support group at your treatment center?

 

If Yes, please list the location, facilitator and contact information to the best of your knowledge:



Please list any additional information or comments about your center here: