Submit a Physician

If you know of a physician who should be included in this site, please contact us with more information.  We would be more than happy to hear from you, and work with you to create a biography about the physician you submit. Please note that the physician you are suggesting must;

  1. Be no longer practicing medicine
  2. Have practiced in Chatham-Kent for a minimum of five years

For each physician included in this site, we would like to include in their biographies such information as their:

  1. Location and date of birth
  2. Education information
  3. Field of medicine
  4. Years spent practicing medicine in Chatham-Kent
  5. Location of medical practice in Chatham-Kent
  6. Location of any medical practices outside of Chatham-Kent
  7. Date of retirement
  8. Hobbies, interests, clubs

We would also like to include a photograph of each physician.  

Upon submission, the Chatham-Kent Physician Team would like to be able to contact you to confirm the information provided.  As such, we ask that you provide either a phone number, or an e-mail address, so that we may be able to reach you.  We thank-you for your interest in the Chatham-Kent Physician Tribute. 


PHYSICIAN INFORMATION:
Physician First Name:
Physician Last Name:
Location of practice:
Years in practice:
to (ie. 1950)
Specialization:

Comments/Other information:
YOUR CONTACT INFORMATION:
Name:
Phone Number:
Email address:
NOTICE: On our web site, we only collect personal information required to improve the services we offer, to improve our site content and, with your permission, to contact you with information about our services. We will not share any personal information obtained on this web site with any other organization.