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Relevant Experience
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Physician’s Declaration of Relevant Experience

I certified that the following is true:

That I am Board Certified in the following areas:

________________________________________________________

That over the last 2 years that I have read ___ articles in peer-reviewed medical journals on Chronic Fatigue Syndrome.

That my experience with this condition is represented below.

Number of patients that I have diagnosis with Chronic Fatigue Syndrome:

 
Number of patient-years that I have treated individuals with Chronic Fatigue Syndrome

 
Number of patients that I have successfully eliminated or made symptom free with Chronic Fatigue Syndrome

 
Number of courses/classes/conferences that I have attended dealing exclusively with Chronic Fatigue Syndrome

 

Physician Name _______________________

Signature _________________________

Date: ___________________
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