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DOCTOR

MEMBERSHIP FORM


You may sign up for 1 Day Doctors by completing this online form. You are not providing information that is not currently public information on the internet.

Texas Medical Board web site provides the following public information on currently licensed physicians, Practitioner’s first and last name, license number, name, mailing address, practice address, birth year, birthplace, medical school, graduation year, license issuance date, license expiration date, registration status and date, county name, gender, and ethnicity. Also includes degree, primary and secondary specialty, practice type, practice setting, and practice time.

 

Information requested that will be listed on our directory page 
Your Name, City, State, Specialty, Image, Phone number, and Website.
1.    Full Name: Include any professional titles (e.g., MD, DO).
2.    Practice Name: The name of the practice or healthcare facility.
3.    Practice Address: Full street address, city, state, and ZIP code. 
4.    Specialty: List all specialties or subspecialties.
5.    Phone Number: Primary contact number for the practice.
6.    Website: If the practice has an official website.

Other information needed to publish profile
1.    Consent to Publish: Confirmation that the information provided can be
       published in the directory.
2.    Phone/email/contact to verify submission
       Ensure all information is accurate and up-to-date to facilitate a complete

       and useful directory listing. 

Other information requested but NOT listed on profile and is not required to sign up to 1 Day Doctors. This information is for our files.
•    Board Certifications: Include any relevant board certifications.
•    Medical License Number: Include the issuing state and expiration date.
•    Fax Number: If available.
•    Email Address: A general contact or administrative email.
•    Office Hours: Typical days and hours of operation.
•    Services Offered: A list of medical services or treatments provided.
•    Insurance Accepted: A list of insurance providers accepted by the practice.
•    Hospital Affiliations: Any hospitals with which the physician is affiliated.
•    Languages Spoken: Languages other than English.
•    New Patient Policy: Indicate if new patients are currently being accepted.
•    Telemedicine Services: Availability of virtual consultations.

Please provide the following membership information for 1 Day Doctors.

(Membership submission information must be verified prior to acceptance)

Date
Month
Day
Year
How did you hear about 1 Day Doctors?

OPTIONAL ------------------------------------------ OPTIONAL

Board Certification?
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