Active or Affiliate Baptist Physician's Record Only.
The form below is either for new Baptist physicians that would like to have a web page on our site OR existing Baptist physicians that do have a web page, but need an addition or correction.

The information submitted below will be reviewed and approved before posting on baptistoneword.org.

  Are You Here To:  
   Create New Page    Edit Existing Page
  If you are here to edit an existing Baptist Physician webpage, all you need to do is enter the Physician's first and last name, enter your name and number, and let us know what the edits are in the comments box at the bottom of this form. Thanks
  General Info:  
  Actual medical specialty:
  Specialty need to be found under:
  Baptist Facility most affiliated with:

  Primary County of Practice:
   
  Physician's Name:  

  First Name

  Middle Name

  Last Name

  Suffix (example: FACC, M.D.)
   
  Practice Information:  

  Practice Name

  Address
  (including city state & zip)

  Phone Number
  (including area code)

  Hours
   
  Education:  

  Med School Name(s)
  Please List and DO NOT abbreviate

  Undergrad School Name(s)
  Please List and DO NOT abbreviate

  Internship School Name(s)
  Please List and DO NOT abbreviate

  Residency School Name(s)
  Please List and DO NOT abbreviate

   
  Certifications, Affiliations
  & Honors:		  

  Board Certifications
  Please List and DO NOT abbreviate

  Affiliations
  Please List and DO NOT abbreviate

  Honors
  Please List and DO NOT abbreviate
   
  Personal Info:  

  Family (not required)
  Example: Married with 3 children

  Hobbies (not required)
  Example: Fishing, Boating, Tennis

  Website (not required)
   
  Photo:  

  If you have a usable scanned image that we can use,
  please attach jpg file in an email to information@bhset.org
  I have one and will email to you.   OR I need a new photo taken
   
  Marketing Services:  
The Award-Wining Baptist Marketing Department can help you grow your practice! We offer great pricing packages on brochures, ads, etc. Yes, I would like more information on how the Baptist marketing department can help me and/or my practice.
   
    Security:  
Please enter your name and phone number (or your office manager's) in case we need to call with a question.


   Your Name

   Your Phone Number
  Additional information
  or comments?:

We will list any questions or additional information that we need on your status page. So, if you are wondering why your info hasn't been posted yet, please login with your username and password and check.
   
  I certify by clicking the enter record button below that the information provided is true and accurate to the best of my knowledge.
 
     
   
 

 
   
 


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