VDFP Communications Submission Form Question Title * 1. Submission heading: (Required.) Question Title * 2. Is the request free of pharmaceutical/industry funding and is not a business? (Required.) Yes No Question Title * 3. Submission information:Please check all that apply. (Required.) This is an opportunity to improve family doctors’ wellness and job satisfaction This opportunity supports family doctors’ ability to meet their patients’ needs This is an opportunity to affirm the value of family doctors and amplify their voice and experience The topic of this request will benefit from Family Practice representation Question Title * 4. I have read the submission guidelines and confirm that my submission aligns with VDFP policy (Required.) Yes No Question Title * 5. Purpose of submission:Please select all that apply (Required.) Primary care research or engagement [MUST be formally approved by a university research ethics board and free from pharmaceutical/industry funding] Job posting Promoting an event Promoting a clinic or service Educational opportunity (non-CME) Soliciting representation for a committee Seeking member perspective Question Title * 6. Communications headline: Question Title * 7. Submission summary:(4 sentences max.) (Required.) Question Title * 8. Link to full information: Question Title * 9. Desired publication date: Question Title * 10. Submitter contact information (Required.) Name Company Email Address Phone Number Question Title * 11. Message to the reviewer (optional) Done
