New Provider Questionnaire for Press Release

Please provide the information requested below.

LinkedIn
This field is for validation purposes and should be left unchanged.
Provider Name*
Practice Name*
Credentials and Education: Upload CV or Resume File
PDF, DOCX, or DOC accepted
Accepted file types: pdf, doc, docx, Max. file size: 32 MB.
and/or Provide Additional Credentials and Education Information
Why did you choose your particular medical profession?*
Why PHC and this particular practice? What made this practice stand out to you compared to others?*
What are some of our particular areas of interest in your specialty?*
What is your philosophy of care for your patients?*
Personal: Family information/hobbies/other
ie: Native of (city/state), spouse, children, community activities, sports, etc)
I would be willing to do a short promotional video.*
- Yes
- No
Any other comments or information to be included: