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The New York State Academy of Family Physicians is compiling a list of family physicians in New York State, along with contact information, career information, and professional interests. Should you choose to participate, the information you provide will be available in the student section of the NYSAFP website so that medical students can contact you with specific questions about family medicine. This database will also be useful for family medicine interest groups (FMIGs) looking for particular speakers for events.

Many medical students have questions and concerns about family medicine. Many also have particular interests but do not know if these interests would work within a family medicine framework. Hopefully, the physician database will become an important resource for students considering a future in family medicine.

Thank you for your interest and participation.


(Please note that because of the way we upload this data onto the website, we are unable to add an "other" box to any of the questions. If you would like to comment on a specific question or add additional information, please type it in at the very end of this survey. Thanks!)

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* 1. Demographics

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* 2. County of your family medicine practice

  County
Please choose

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* 3. Degree: Check all that apply

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* 4. Type of practice: Check all that apply

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* 5. Residency training:
Are you currently a resident?

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* 6. Does your practice include (check all that apply):

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* 7. Please indicate professional interests (Check all that apply):

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* 8. Students can contact me with questions about family medicine.

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* 9. Students can contact me about speaking at events.

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* 10. Do you currently have an academic appointment with a medical school?

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* 11. If yes, which medical school/s?
(check all that apply)

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* 12. Do you currently supervise medical students in your practice?

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* 13. Do you have any additional comments you would like to share?

Also, please feel free to note any additional information you were unable to add into any of the previous questions. (Please type in a brief description of the question before you add more information. i.e. Other professional interests include: ___)

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