Partners In Medicine Membership Form
Partners in Medicine (PIM) is a group dedicated to supporting the significant others of University of Utah physician interns, residents, fellows, and attendings.  We provide a support group to families who are in this transitional stage in life.

All spouses and partners of physicians (interns, residents, fellows, attendings, faculty) associated with the University of Utah are eligible for membership. Annual membership dues are $25 ($35 for attending spouse) and entitle you to a copy of the PIM monthly newsletter with detailed monthly club events and updates, a PIM member directory, and most importantly, the opportunity to meet people going through similar life experiences.

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Physician Name(s) *
Physician Email
Partner Name (PIM Member) *
Partner Birthday *
Partner Email (Newsletter will be sent here) *
Partner Occupation *
Utah Address (if known)
Cell Phone *
Would you like to be added to our PIM Groupme? *
Children's Names and Dates of Birth
Physician's Program *
Year Arrived *
Anticipated Year of Completion *
Status of Physician Partner (choose one) *
Where did you live before SLC?
How did you hear about PIM (choose all that apply) *
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