Request edit access
2023 Doximity Digital Health Fellowship Application
Thank you for your interest in participating in Doximity's Digital Health Fellowship for 2023! See our blog post to learn more about the program.

Sign in to Google to save your progress. Learn more
Please provide the email you use to sign into your Doximity account. Applicants must have a Doximity profile. If you're not a member, please register for free at Doximity.com. *
First and Last Name *
Title *
e.g. Assistant Chief of Family Medicine
Institution *
e.g. UC Health
Specialty *
What is your primary clinical practice setting?
*

One of the core requirements of this Digital Health Fellowship is to give a talk or presentation. Please give an example of a recent talk you've given, including the topic and audience.

*
If you haven't had the opportunity to give a talk, we still encourage you to apply for the Fellowship. Please let us know about any plans or opportunities you may have for upcoming presentations.
Please add links to any professionally-oriented social media accounts you have.
Ex: linkedIn.com/in/DrJaneSmith Twitter.com/DrJaneSmith, Instagram.com/DrJaneSmith
Please list any upcoming medical meetings you plan on attending.

Please list any medical associations, societies or organizations of which you are a member. Please note any leadership roles you hold at these organizations.

Which of Doximity's digital health tools do you currently use? *
Required
Can you recall a specific time when Doximity was particularly helpful to you and/or a patient? (please refrain from sharing any PHI. 250 word limit.)
Please describe your interest in joining Doximity's Digital Health Fellowship. What would you like to accomplish? What are you hoping to learn? What qualifications would you like to highlight? (500 word limit) *
How did you hear about this Fellowship? *
Referred By (Optional)
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of Doximity. Report Abuse