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Pro Hub Intake Form
Ready to elevate the visibility of laboratory medicine? Share your expertise and help shape the future of diagnostic understanding.
This initiative is in collaboration with the American Society for Clinical Laboratory Science (ASCLS).
*
1.
Full Name
(Required.)
2.
Laboratory Specialty/Discipline - to match expertise with content needs (select all that apply)
Clinical Chemistry/Clinical Biochemistry
Hematology/Hemostasis
Cytogenetics
Microbiology/Bacteriology
Laboratory Education
Immunology/Immunohematology
Toxicology
Molecular Diagnostics
Virology
I am a student under mentorship using this platform
Other (write in)
3.
Credentials/Certifications (select all that apply)
PhD
DrPH
MD
DCLS (Doctorate in Clinical Laboratory Science)
MLS (Medical Laboratory Scientist)
MT (Medical Technologist)
MLT (Medical Laboratory Technician)
MB (Molecular Biology)
M (Microbiology)
SC (Specialist in Chemistry)
SH (Specialist in Hematology)
SM (Specialist in Microbiology)
Other (please specify)
*
4.
Years of Experience - to understand expertise level
(Required.)
*
5.
Areas of Interest (select all that apply) - to align with specific engagement opportunities
(Required.)
Q&A for health consumers → Answer patient-submitted questions about lab test results
Q&A for healthcare professionals → Respond to questions from healthcare providers about lab results
Featured lab professional video interviews → Participate in video interviews about your lab expertise
Articles and Publications → Author educational content on laboratory diagnostics and testing
*
6.
Professional Organization Affiliations (select all that apply)
(Required.)
American Society for Clinical Laboratory Science (ASCLS)
Association for Diagnostics & Laboratory Medicine (ADLM)
American Society for Clinical Pathology (ASCP)
American Society for Microbiology (ASM)
Association of Public Health Laboratories (APHL)
College of American Pathologists (CAP)
Other professional laboratory organization (please specify):
*
7.
Estimated Question Volume Preference (select one)
How many questions would you feel comfortable answering per month?
(Required.)
1-5 questions per month
6-10 questions per month
11-20 questions per month
20+ questions per month
40+ questions per month
Flexible/varies by month
I won't be doing Q&A
*
8.
What is your favorite laboratory quote or saying? (keep quote under 12 words)
Examples
> 'Every test tells a story'
> 'In the lab, mistakes are learning opportunities'
> 'Trust the process, verify the results'
(Required.)
9.
What number of "questions answered" should we start the ticker with?
*
10.
Comfort level with technology
(Required.)
1
5
Clear
*
11.
What state do you reside in?
(Required.)
*
12.
Email - for secure communication
(Required.)
13.
Phone Number - alternate contact method
14.
Opt in to our newsletter
Yes, I'd like to receive updates on trending patient questions and diagnostic insights from the community.
15.
Which healthcare non-profit organization would you like your proceeds donated to?
American Society for Clinical Laboratory Science (ASCLS)
Northeast Association for Clinical Microbiology and Infectious Disease (NACMID)
HEM Foundation | Health Equity Matters®
Other (write in)
Thank you for your interest in joining the Pro Hub. Our team carefully reviews each application and will contact you within 7 business days. For any questions, please contact at
team@
diagnosticequity.org
16.
How did you hear about Diagnostic Equity?
ASCLS/CIRT
LinkedIn
Google/Organic Search
My Educational Institution
Other (please specify)
