Find an Adult Provider - Association for the Bladder Exstrophy Community

We understand that finding an adult provider who specializes in exstrophy related conditions can be difficult. If you are having trouble locating a provider in your area please complete the form below. Make sure to check our adult provider directory for updated info about providers in your state.

Adult Provider Request

Name*
First Last
Date of Birth*
MM slash DD slash YYYY
Address*
City State / Province / Region ZIP / Postal Code Country
Phone*
Email*
Name of Requested Provider (if known)
Preferred method of contact (from provider's office)*
- Select All
- Phone
- Email
Primary Diagnosis (e.g. BE, CE, EPI)
Summary of Major Surgeries and Bladder Management
Current Problem/Concern
Additional Comments