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!

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Example: Provider Bio Page

<span style="font-size: 10pt; color: #666699;"><em>Example: <a href="https://www.fairview.org/providers/HalversonPhilip-1962448743" rel="nofollow" target="_blank">Provider Bio Page</a></em></span>

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* 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.

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* 2. Practice/Clinic information

Practice/Clinic Name *

Primary Clinic Location *

Address

Address 2

City / Town

ZIP/Postal Code

Practice Website

Phone Number

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* 3. Other locations where you see patients (city or address)

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* 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)

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* 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)

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* 6. Site of Medical School

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* 7. Site of Residency

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* 8. Site of Fellowship (and area of specialty)

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* 9. Site of Masters (and degree earned)

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* 10. Site of Ph.D. (and degree earned)

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* 11. Other Education

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* 12. Philosophy of Care (one to two sentences on how the provider views his/her practice).

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* 13. Clinical/medical Interests (e.g., prenatal care, diabetes, sports injuries)

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* 14. Research Interests

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* 15. Honors (awarded in the past 5 years)

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* 16. Publications (published in the past 5 years)

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* 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)

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* 18. Upload your provider bio portrait for our website (see instructions)

GIF, JPEG, JPG file types only.

Choose File

No file chosen

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* 19. Please enter your contact information (if different from provider).

Full name

Title

Phone Number

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Example: Provider Bio Page

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* 1. Provider information

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* 2. Practice/Clinic information

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* 3. Other locations where you see patients (city or address)

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* 4. Hospital Privileges (check all that apply)

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* 5. Languages other than English (check all that apply)

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* 6. Site of Medical School

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* 7. Site of Residency

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* 8. Site of Fellowship (and area of specialty)

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* 9. Site of Masters (and degree earned)

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* 10. Site of Ph.D. (and degree earned)

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* 11. Other Education

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* 12. Philosophy of Care (one to two sentences on how the provider views his/her practice).

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* 13. Clinical/medical Interests (e.g., prenatal care, diabetes, sports injuries)

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* 14. Research Interests

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* 15. Honors (awarded in the past 5 years)

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* 16. Publications (published in the past 5 years)

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* 17. Other names you go by (maiden) or ways people incorrectly spell your name (for Web site keywords/search terms).

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* 18. Upload your provider bio portrait for our website (see instructions)

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* 19. Please enter your contact information (if different from provider).

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* 20. Additional comments, questions or requests?