New Provider Profiles

The information you enter on this form will be transferred to your uihc.org or uichildrens.org profile. Please take a look at an example: Keith D. Carter, MD, FACS. This form may take 10-15 minutes to complete.

About
(check all that apply)
(i.e. "Jane Doe" or "Jane X. Doe")
Languages that you would like noted on your profile.
If not, please schedule an appointment to have your professional portrait taken.

Personal Statement

To enhance your profile, we would like to include a personal statement from you to your patients. You can use these questions to help guide your quote:

  • My favorite thing about my job is...
  • I joined UI because...
  • I like working with patients because...
  • What is special about UI Hospitals & Clinics?
  • What inspires you to practice medicine?
E.g., 01/2021
Degrees

Please include undergradute, graduate and medical degrees (examples: BA, BS, MD, MSN, PhD, MBA, etc.). If you have additional degrees, please include them in the comments at the end of the form.

Example: BA, Biology, University of Iowa, Iowa City, Iowa
Degree, Institution, City, State
Degree, Institution, City, State
Degree, Institution, City, State
Residencies
Area (e.g. Emergency Medicine), Institution, City, State
Area (e.g. Emergency Medicine), Institution, City, State
Area (e.g. Emergency Medicine), Institution, City, State
Fellowships
Area (e.g. Emergency Medicine), Institution, City, State
Area (e.g. Emergency Medicine), Institution, City, State
Area (e.g. Emergency Medicine), Institution, City, State
Area (e.g. Emergency Medicine), Institution, City, State
Area (e.g. Emergency Medicine), Institution, City, State
Area (e.g. Emergency Medicine), Institution, City, State
Credentials
(e.g. American Board of Dermatology)
(e.g. American Medical Association)
Employment Details
This is the 8 digit number found on your UI Health Care ID
Check all that apply
Patient Care
(Dermatology, Oncology, etc.)
(Dermatology, Oncology, etc.)
(MRI, Meniscus repair, etc.)
Clinical Appointments and Referrals
Medical Services
Additional Information
Please include any information you feel is missing: additional locations, degrees, languages, etc.