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Clinician Bios and Headshots

Submission Form

Please provide us with the most up-to-date information possible. This information will help us keep your professional bio current.

Please use the first name you go by and would like featured on the website or in your printed bio.
Clinician Type*
For categorization purposes
List all that apply separated by commas.
Please upload an unedited, uncropped photo of yourself. Tips for taking a great headshot - Use Portrait Mode, face the window for sunlight, turn slightly and do not stand flat up against walls.
Drop files here or
Max. file size: 50 MB.
    Max. file size: 50 MB.
    Are you any of the following?
    Please check all that are applicable.
    Online Bio Acknowledgment*
    Print Bio Acknowledgment*