Find A Doctor
The information you enter here is what will appear under your name on the "Find A Doctor" feature on the new Doctors Hospital website.The information is primarily intended for potential patients to make appointments. All information provided (except your medical license #) will be made public on the site. The medical license is just for internal verification purposes.
Please submit your responses no later than Friday, December 8, 2017.
If you have any questions or concerns about this form, please contact
Email address *
First Name *
Your answer
Last Name *
Your answer
Please select the appropriate designation that will appear next to your name ie John Doe, MD. If you do not wish to have a designation appear next to your name, leave this field blank.
Post Nominal Letters (ie M.B.B.S, F.R.C. Urol etc)
Include all that apply in the order you wish them to appear under your name.
Your answer
Medical License # *
This will not be made public and is just for DH verification purposes.
Your answer
Do You Hold Sessional/Specialist Clinic Hours? *
Please indicate if you hold clinic hours at the Doctors Hospital or Blake Road Sessional Clinics
Office Location
Please indicate the location of your private practice if applicable.
Your answer
Telephone Contact: *
Please provide your office telephone number.
Your answer
Other Phone (optional)
Please add your cell or any other phone number here ONLY if you want the public to access you this way.
Your answer
Please provide the URL for your private practice website in the format requested. Please ensure you enter http:// at the beginning of the address, ie
Your answer
Primary Specialty *
Please select the primary specialty you would like to be listed under. Note, you will appear on the list for each of the two specialties you select.
Secondary Specialty
If applicable, please select the Secondary Speciality you would like to be listed under. Note, you will appear on the list for each of the two specialties you select. If you have only a primary specialty, you can leave this field blank and submit your data.
A copy of your responses will be emailed to the address you provided.
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