Enhanced Provider Information

In an effort to better market your services and to better connect with our patients, senior leadership has requested that we improve the listing information for the providers throughout our organization. This form should take about 30-minutes and you should review the information we are requesting before you begin filling it out. There is an option to save and continue filling out the form at a later date. If you need to pause your submission, please scroll to the bottom of the page and click on ‘Save and Resume Later’. A link will be emailed to you so that you can resume your form submission at a later date.

We will use the information that you include to create a more in-depth bio for your profile page on the website and will be used to market your services. Please take the time to make sure the content is accurate and in-depth.

If you already started filling out the form and you can’t find the email with your link to complete the form, email: max@gizmoproductions.com and he will send you the link.


Specialty or Specialties

What are your specialties and subspecialties? Please list any fields that you specialize in as a list in separate bulleted lines. If you do not have a specialty or subspecialty, please leave the text box blank.

For Example:
  • Urology
  • General Surgery


For general services, please list as many as you can, separated by commas (I.E. Vasectomies, Vasectomy Reversals, and Kidney Stone Removal). We understand that this list might get quite long, but we want to make sure we have all your services included in your listing.

We are also asking you to list 5 services that you think you excel at or want the community to know you offer. If you can offer additional information about the services, that would be ideal. Please format this as a bulleted list, similar to the following example.

  • Vasectomy Reversals
    Many men that get vasectomies don't know that they are reversible. I have spent the last 20 years of my career specializing in reversing vasectomies. The process is simple, minimally invasive and you'll be back on your feet in a week.
  • Kidney Stone Removal
    information here
  • Laparoscopic Surgery
  • Urinary Incontinence
  • Bladder Infections

Personal Story & Professional Story.

No one likes to write their own bio, but it's a great way to introduce yourself to patients. It gives them the chance to get to know you outside of the clinical setting and can be very helpful in creating a better care experience for the practitioner and the patient. Please answer the following questions so that we can help write a bio to be included in your enhanced provider listing. Be as specific as you can in your answers, more information is always better than less!

Education, Achievements, and Certifications.

For each of the following please create a list using the following structure as an example. Keep in mind that this information is for the general public, not a job application so avoid abbreviations and focus on information that helps support the caliber of your care.

  • University of New Mexico School of Medicine, Completed 2000
  • Massachusetts General Hospital, 2006-2008
  • American Board of Emergency Medicine, Completed 2010
Click or drag files to this area to upload. You can upload up to 2 files.

Additional Information

This is your opportunity to share any additional information with your patients. We are including an additional file upload option and we would like you to upload at least three photos that feature you.

Consider including the following:

  • Photo from your medical school graduation or your first residency.
  • A photo of you doing something you love, or something fun that is not work related.
  • A photo of you that represents a happy and important memory. Maybe a photo of your wedding day, or a photo with your family, or a photo of finishing a marathon.
Click or drag files to this area to upload. You can upload up to 5 files.
You can upload up to 5 photos.