Physicians: Share Your News

Please complete the following form to report newsworthy items about yourself or your practice. For questions or more information, contact Marketing and Communications at 889-2271.

Thank you.

Name:
Phone number where you prefer to be reached: (office, cell or pager)
Would you like to receive e-mail reminders to report newsworthy items?	Yes     No
Email Address:
What have you done that is new? (Presented at a conference? Learned a new procedure? Written a book or published an article? Etc.)
Are you the only physician performing a certain procedure in our area?	Yes     No     If yes, please indicate:
Have you begun doing a procedure that is new to our area?	Yes     No     If yes, please indicate:
Are you available for media interviews on these or other topics?	Yes     No     If yes, please indicate:
Would you like us to consider an article in Healthy Living Magazine (the publication reaches almost 20,000 homes in the community) on this topic(s)?	Yes     No
Any other topic suggestions for the media or magazine?
Would you like to do a 30- to 45-minute talk at a Healthy Living Club community presentation? These are held at one of the hospital campuses, in the daytime or evening, with attendance of 30 to 80 people.	Yes     No   If yes, please indicate: