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VMP Profile Form

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• For Doctors
• VMP Profile Form

Your Details

Title *

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e.g. Dr, Prof

(?)

Credential Initials *

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e.g. MBBS (Qld)

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First Name *

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(?)

Surname *

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(?)

Specialty Area *

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(?)

Sub specialties

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(?)

Contact Details

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(?)

Rooms/practice name

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Telephone Number*

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Please include area code e.g. 07 3834 4444

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Fax Number

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Email

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(?)

Website address

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e.g. www.yourpractice.com.au

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Practice Manager/Secretary contact details

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Upload a profile photo

maximum file size 3mb

Background information

Education and Training*

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(?)

Experience

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(?)

When did you begin practising?

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e.g. November 2001

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Sunshine Coast Private Hospital Commencent Date

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e.g. March 2013

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Research

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current or recent

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Additional information

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(?)

Memberships

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i.e. professional organisations

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Market your profile

I would like my VMP Profile details used in hospital marketing material