NEW DOCTOR questionnaire

To help Eyemedics with setting up your online profile and your general marketing presence, please complete the form below. The details you provide will be for the exclusive use of Eyemedics only.

If you prefer to provide this information in a meeting, please contact Dave Green on 0439 900 092.

Name:

Accreditations/title (eg MBBS, FRANZCO):

Previous experience if relevant:

Specialist field/s:

Detail any particular fields of interest and why (for awareness in areas you wish to increase growth in):

Are there any areas you don’t wish to market to?

Memberships of any formal associations/ fellowships/ medical related committees:

Involved in any specialist training, research or public teaching?:

Any eye-related philosophies, passions, beliefs, insights, aims?:

Worked for any overseas aid/Australian ‘aid’ type eye programs (eg Fred Hollows Foundation, Pro Bono work, Aboriginal communities):

Personal interests (helps to show the human side of the practice) – include hobbies, passions, sporting interests etc: