Healthcare Heroes & Leader

Please complete the form below to be included in Healthcare Heroes & Leaders, a special section of Feeling Fine and The Community Voice highlighting healthcare professionals serving communities in our distribution areas. The form should take approximately 5–10 minutes to complete and includes an option to upload a professional headshot.

Physician's name(Required)
Accepting New Patients?(Required)
Primary Practice Address(Required)
Other Practice Address
Your Email(Required)
Include major and university
Medical School and specialist certifications
Business/Marketing Contact(Required)
This question applies to the next three presented options for possible next steps.
Community recognition receptionitled(Required)
Community wellness and healthcare expo event(Required)
Health education forums and workshops(Required)
Max. file size: 2 GB.