Register - Hemifacial Spasm Association


Membership in the HFSA requires two things, an ongoing workable e-mail address and a Member Profile.

Please fill out the form below as completely as possible - If your e-mail address is not complete, accurate and functional, we can't communicate with you or activate your membership. Required fields are in red and marked with an * but all information will benefit your fellow members! You may edit or delete your profile at any time, but deleting your profile will terminate your HFSA membership.

NOTE: Information contained in your Member Profile and on our entire website is available for viewing by anyone with Internet access.

Login Name (Please use your first initial and last name, i.e. jdoe for John Doe
Password *:
Password again *:
First Name *:(Please use the name you want us to know you by. If your name is "William" but you go by "Bill", please enter "Bill" as your first name)   Last Name *:
E-mail *: Please assure that e-mail address is correct!
City *:
State/Province *:
Country *:
Gender *:
Marital Status:
Occupation:
Your Age at HFS Onset *:
Side of Face Affected *:
Calendar year of HFS Onset *:
Symptoms Experienced *:  
Medications Tried:
(Include comments on
effectiveness and/or side effects)		  
Alternative Treatments Tried: (Include comments on effectiveness and/or side effects)  
Have you tried Botox *?
If tried, are you still using it?
Botox Comments:
(Include comments on
effectiveness and/or
side effects)		  
Have you had an MVD *?
Number of MVD's:
Date of last MVD: ,  (Month, Day, Year)
Name of last Doctor who
performed your MVD?
Facility where last
MVD was performed?
(Name & address)		  
If you had an MVD,
are you Spasm Free?
If Yes to MVD, any
continuing complications?		  
Miscellaneous Comments:  

Questions? Click Here

Copyright © 2001, The Hemifacial Spasm Association (HFSA) Rev. 062101
Hemifacial Spasm Association - 2001