Specialty Provider Profile

We are asking our specialty care providers to provide the following information in effort to improve the information we offer on our website. This added detail will help us improve provider profiles on our website and allow us to better promote our providers and services. This form should take about 10-15 minutes to complete. Thank you!

All fields with asterisk next to them are required.  

Getting to know you questions

Please list information you are okay sharing with patients.

About Your Practice/Area of Specialty

Special Interests/EDI Considerations

Consider the types of patients you enjoy working with. This does not mean that you have special courses or received any special training. Think about this in terms of the types of patients, ailments, issues you enjoy assisting patients with as part of your specialty and practice. This is a way for patients to research and identify if you will be a good fit for them.

To better serve our patients, Memorial is compiling a list of physicians who are comfortable caring for LGBTQ+ patients both in terms of their general health and in terms of discussing their sexual orientation and gender identity in an affirming way. A “safe-space” designation may be added to your website profile. This would tell a patient you are comfortable having discussions around this topic in a sensitive and affirming way.

Additional Information

Thank you for your time in providing this information.