ASK A DOCTOR NETWORK
Expert Application

Please complete the required fields below. All application materials MUST be submitted for consideration into our Ask a Doctor Network. We will send an email confirmation once we receive your completed application. If you have any questions, please feel free to contact us at any time.

PERSONAL
First name
  Middle initial
Last name
Gender
Email
Place of work
Work address
Work telephone number
(medical practice, hospital, clinic, etc. no cell phones, please) ( Why this? )
Maximum questions that you can answer per day
Days you are available to answer medical questions
Sun Mon Tue Wed Thu Fri Sat
 
EDUCATION
University name
Date of graduation
Degree, Diploma, Certification
Area of medical practice
State/Nation in which I am licensed
Certification/registration number
  Other evidence of formal qualification
 
SPECIALTY
  Do you have a certification of specialist training?
  In which forums would you like to answer medical questions?
Any forum



 
ATTACHMENTS
1. Photo - Your photo will appear next to your posts, and on your profile page.
 
2. CV - Please include a list of your medical training, professional affiliations and publications in your current CV. We list these details on your profile page.
 
3. Formal qualification documents - Please send us a copy of your State Board of Medical Examiner`s license, certification, sub-certification or registration document. We verify the status of all applicants` issued credentials.
 
 
TO SUBMIT BY FAX: Please fax a photo, CV and copy of your qualifying document(s) to (954)697-3100.
TO SUBMIT ELECTRONICALLY: Please upload the following documents:
  • The documents can be in RTF, DOC, DOCX or TXT format
  • The documents can be a JPG, GIF, or PNG image
 
 
By clicking "I Agree" below you agree and consent to our Ask a Doctor Publishing Agreement.
 
I Agree