FPA Network Provider Bio Submission Form Join your FPA Network colleagues on Fairview.org! Please complete this form to add or update your provider bio on Fairview.org. Please contact Lisa Rosemeyer with any questions or call 952-914-1843. Scroll down to get started. Thank you! Question Title Example: Provider Bio Page Question Title * 1. Provider information Provider Full Name * Credentials (MD, PA, etc.) * Medical Title (e.g., Oncologist) * Specialty(s) (e.g., OBGYN) Board Certification (not board eligible) Provider Email Address Note: FPA Network does not share provider emails or post them on bios. Emails are a requirement for network communication. Question Title * 2. Practice/Clinic information Practice/Clinic Name * Primary Clinic Location * Address Address 2 City / Town ZIP/Postal Code Practice Website Phone Number Question Title * 3. Other locations where you see patients (city or address) Question Title * 4. Hospital Privileges (check all that apply) Bethesda Hospital Fairview Lakes Medical Center Fairview Northland Medical Center Fairview Range Hospital Fairview Ridges Hospital Fairview Southdale Hospital Grand Itasca Hospital HealthEast St. John's Hospital HealthEast St. Joseph's Hospital Maple Grove Hospital University of Minnesota Masonic Children's Hospital University of Minnesota Medical Center Woodwinds Health Campus Not applicable Other (please specify) Question Title * 5. Languages other than English (check all that apply) ASL Amharic Chinese French German Gujarati Hindi Hmong Marathi Oromo Punjabi Russian Slovene Somali Spanish Vietnamese Yoruba Other language(s) Question Title * 6. Site of Medical School Question Title * 7. Site of Residency Question Title * 8. Site of Fellowship (and area of specialty) Question Title * 9. Site of Masters (and degree earned) Question Title * 10. Site of Ph.D. (and degree earned) Question Title * 11. Other Education Question Title * 12. Philosophy of Care (one to two sentences on how the provider views his/her practice). Question Title * 13. Clinical/medical Interests (e.g., prenatal care, diabetes, sports injuries) Question Title * 14. Research Interests Question Title * 15. Honors (awarded in the past 5 years) Question Title * 16. Publications (published in the past 5 years) Question Title * 17. Other names you go by (maiden) or ways people incorrectly spell your name (for Web site keywords/search terms). Add a photo to your provider bio!Your photo must meet these requirements: Color photo with a simple gray backdrop, showing head and shoulders Photo resolution must be 300 DPI and (1650 X 2305 px) Business attire (avoid lab coat, scrubs, large jewelry, seasonal/holiday clothing) Question Title * 18. Upload your provider bio portrait for our website (see instructions) GIF, JPEG, JPG file types only. Choose File Choose File No file chosen Remove File Upload your provider bio portrait for our website (see instructions) Question Title * 19. Please enter your contact information (if different from provider). Full name Title Email Phone Number Question Title * 20. Additional comments, questions or requests? Done