Register - Hemifacial Spasm Association


Membership in the HFSA requires two things, an ongoing workable e-mail address and completing and retaining an onsite 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 on our entire website, including member information, is available for viewing by anyone (members and non-members) with Internet access. Through the sharing of our personal experiences, others are helped.


Login Name (Please use your first initial and last name, i.e. jdoe for John Doe)*NOTE: Do not use symbols or spaces such as "j_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:  

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