Specialist Entry Form

THERE IS NO CHARGE FOR THIS ENTRY.

APPROVED ENTRIES USUALLY GO LIVE ON SAME OR NEXT WORKING DAY. 

NOTE: FIVE IS THE MAXIMUM NUMBER OF SPECIAL INTERESTS AND ALSO THE MAXIMUM NUMBER OF PUBLISHED WORKS.

   

Surname

First Names

Professional Title (Prof,Dr, Ms etc)

Professional Qualifications (Abbreviated please)

Medical Council Registration Number

Undergraduate Medical School

Year of Graduation

Consultant Speciality

Academic Positions Held

Special Clinical, Academic or Research Interests you would like to list (maximum of 5): (Please be specific and avoid terms such as General Psychiatry or All aspects of Dermatology – these are implicit in Consultant Speciality)

Addresses and Contact Numbers of all Hospitals, Clinics, Rooms which you attend

Address

Telephone

Fax

Your Email

Your Website

Mobile Telephone

Home Telephone

Twitter

Other Professional, Clinical Positions/Affiliations/Memberships Held – home or abroad: (Say ‘Past’ if not current)

Published Works: (State whether Author/ Co-Author etc, 'Name of Paper', Publication Details).