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>

Provider information

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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.

Practice/Clinic information

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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

Other locations where you see patients (city or address)

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

Hospital Privileges (check all that apply)

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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)

Languages other than English (check all that apply)

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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)

Site of Medical School

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* 6. Site of Medical School

Site of Residency

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* 7. Site of Residency

Site of Fellowship (and area of specialty)

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

Site of Masters (and degree earned)

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* 9. Site of Masters (and degree earned)

Site of Ph.D. (and degree earned)

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

Other Education

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* 11. Other Education

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

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

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

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

Research Interests

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* 14. Research Interests

Honors (awarded in the past 5 years)

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

Publications (published in the past 5 years)

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

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

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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)

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

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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

Don't have a photo that meets the requirements? No worries!

FPA Network will reimburse FHN providers for the cost of portraits, up to $50 each, with receipt. If your practice is not part of FHN, we can help you update your portraits at your expense. See below for options.

Please select one of these photo options and we will contact you to make arrangements:

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* 19. Please select one of these photo options and we will contact you to make arrangements:

JCPenney portrait studio - $49.99 for one high-res digital image. (A limited number of pre-paid portrait certificates are available at no charge for FHN independent member providers.)

Request a photographer - FPA will send a photographer to your location to photograph five or more providers, schedule permitting. (Fairview Health Network member independent practices will not be billed.)

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

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

Full name

Title

Phone Number

Additional comments, questions or requests?

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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 select one of these photo options and we will contact you to make arrangements:

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

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* 21. Additional comments, questions or requests?