MD++ Member Directory Form
Welcome to our MD++ community! We empower the next generation of physician-innovators who will improve healthcare delivery through the intersection of technology, business, health policy, and life sciences. Your email will not be displayed in the member directory, unless you choose to specify it within "Contact". Your email will only be used for MD++ community contact purposes.

Please note it may take some time for your information to be populated into the MD++ Member Directory (hosted by Airtable).

An email receipt of your responses will be emailed to you containing a link to update your form responses. Please keep this in your inbox if you want to change your directory information. If your email gets lost or buried, please reach out to @Lathan on Slack.
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Email *
Full Name *
Medical School *
Graduation Year *
Please enter the calendar year (e.g. 2025) you anticipate graduating in/that you graduated in.
Medical Program *
Either working towards or already achieved. If your other degree is not listed here, please choose an option that's most similar (e.g. PhD ~ ScD). If that's not possible, select Other.
If you're not currently in medical school (for example, you've graduated or you're taking an extended leave of absence), what is your current institution or company?
Please enter the INSTITUTION only, you can specify your role in the next question. Feel free to write in here if you have a significant part-time position outside of your academics as well!
If you're not a full time student/have a significant part-time position, what is your current role?
E.g. PGY1 in Internal Medicine, Fellow, Consultant, CMO, Venture Fellow. Feel free to write in here if you have a significant part-time position outside of your academics as well!
Previous Affiliations *
A comma-separated list of previous schools, companies, organizations you were a part of.
Additional Graduate Degrees *
Describe any additional graduate degrees you have (e.g. Master's, PhD, JD, etc.)
Required
Previous Experiences *
Required
Previous Job Experience(s)
Please indicate previous roles you have held in a comma-separated list, if any.
Interests *
Required
Would you like to join an interest specific mentorship group with other MD++ members? If yes, please fill out the mentorship form: https://forms.gle/JH1zL7F4zVSqPbu3A *
Contact
This field is optional, but please feel free to include you slack handle, email, phone number, or whatever other social media link!
A copy of your responses will be emailed to the address you provided.
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