OFP Specialty Peer Reviewer Interest Form

OFP Specialty Peer Reviewer Interest Form
Name *

First Name Last Name
Designations/Credentials *
e.g., DO, FACOFP
Email *
example@example.com
Mobile Phone Number *

Area Code Phone Number
Program, Practice or Other Organization Name *
Current Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Are you a current ACOFP member? *

Yes No
Current CV *

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Please select up to five areas of expertise in osteopathic family medicine. *

Academic Medicine Addiction Medicine Behavioral Health Cardiology Clinical Images Community Medicine Dermatology Diversity, Equity and Inclusion Emergency Medicine Endocrinology Ethics General Family Medicine Geriatrics Health Literacy Health Policy Medical Education Men's Health Military Nutrition and Obesity Obstetrics/Gynecology OMT/OMM Pain Management Patient Education Pediatrics Physician Wellness Practice Management Pulmonary Rural Medicine Sports Medicine Vascular Women's Health Wound Care
High-Resolution Headshot

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I am interested in sharing my expertise in other areas of ACOFP (e.g., webinars, presentations, blogs, etc.) *

Yes No
I hereby grant ACOFP the perpetual, absolute and irrevocable right and permission to use, reproduce, edit, exhibit, project, display, copyright, publish and/or resell photographic pictures that I provided and to circulate the same in all forms and media (including, but not limited to: on the ACOFP website and in any publications, any advertising/promotion, videotapes, audio tapes, compact discs, computer files and photographs) for educational, trade, all forms of advertising/promotion or any lawful purpose. I waive all claims to compensation and damages.
Please email OFP Managing Editor Grace Johnson Adams at gracea@acofp.org with questions.
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