Doctors on Task Application

To preserve an atmosphere of safety and to maintain the integrity of the group, we ask that you fill out our “application” and share a bit about yourself. 

Due to the sensitive nature of some struggles, we strive to create a group that does not have physician/patient or colleague/colleague conflicts of interest. For example, you might be the treating physician for one of our participants or collaborate on a project with another. It's a small world and we want everyone to feel safe to discuss their struggles and receive support.

You will be notified within 5 business days whether the group is a fit for you or not.

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Email *
Name *
Phone Number *
Please share proof of physician status (NPI or medical license #, a website, etc.) *
Where do you live?
Who referred you or how did you learn about this group? *

Your name and location may be shared with group participants. 

Other information will be used for correspondence between you and facilitator, Barb Hubbard, and for identity verification purposes only.

A copy of your responses will be emailed to the address you provided.
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