Physician or Medical Professional Profile Q&A

Resident Medical Professional Profile
Each month, we want to highlight a medical professional in our community publication. to be featured please provide the following information and 5-8 high-resolution (300 dpi) photos of you, (your family), your business associates, office and of your work to be featured in the article.

Use the questions to prompt your thoughts of what you would like to share. Not all of the questions will fit your story, but most will, so feel free to add to the information and make it your own. Once you submit the answers our team will be in touch to let you know if we need anything else.

Thank you for your involvement in your community.
Best Contact Info

Please provide your personal contact info for the Editorial Staff to communicate with you through the publishing process. Later in the form you can provide the business contact info to be published in your article.
In which neighborhood do you live?
Is this a self-submission or did someone request you to make this submission?*
Who requested? Publisher Jenni Eifler? A Resident writer? Our content coordinator, Mary Pittman?
This Q&A is greatPhone interview is idealI'll fill out this Q&A but have more details I'll share via a phone call
Name*

First NameLast Name
Email*
example@example.com
Phone Number*

Area CodePhone Number
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Yes, pleaseNo, thanks
File Upload - Submit Photos Here

Browse Files
Please send a headshot or a picture of yourself, family photos, office or team pics, plus any logos- ideally we would have 5-8 images to choose from Cancelof
Professional History and Information

Background Info and Story
What is your area of medicine?
Please describe this field of medicine, if necessary.
What prompted you to go into this field of medicine?
Where did you go to college? Where did you go to medical/dental/etc. school? Where did you do your residency etc?
How long have you been practicing medicine?
Given your medical expertise and the nature of what you do, what advice (whether general or specific) can you offer to the residents of your neighborhood, if applicable?
About You

Your background and story
Where did you grow up?
Tell us a little about your family.
How long have you lived in the area? What brought you to live here? What is your favorite part of living in the neighborhood?
Do you have any special interests or hobbies you would like to share?
Are you involved in the community or do you support a special cause you would like to tell the neighborhood about?
Additional Information to share with the readers
Business Contact Information
phone, address, website, email, etc.
Anything else you would like to include?
Can you share with us what you love most about your private monthly publication?
Would you like any extra copies? If yes, how many? (Up to 1 provided for FREE - $8 per additional)
If none, enter 0
Social Sharing

Our Instagram accounts are a great way to further connect neighbors, business partners, families and friends. Please review the two sections below regarding social sharing. We promise to always respect your privacy and will only use first names if your submisison is shared online.
YesNo
We'd love to tag you! Please provide your username/handle.
@example
Nominations

We don’t want to leave anyone out. Do you know another physician in the neighborhood you would like to nominate for a Physician Profile story?
Name

First NameLast Name
Email
example@example.com
Phone Number

Area CodePhone Number
Any Additional Comments or Thoughts
Should be Empty:

Resident Medical Professional Profile

Best Contact Info

Professional History and Information

About You

Additional Information to share with the readers

Nominations