Add Physician Profile to Find-A-Doctor Locator

Use form below to add a physician profile to the Find-A-Doctor locator.

If you require additional assistance, contact:
E: info@tenexhealth.com
P: 949.454.7500

Doctor Finder Profile Form

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1 Step 1

Submitted by

Name(first, last)

Phone

Physician information

First Name

Last Name

If speciality listed is "Other", please specify here

Practice Name

Practice Website

Physician Email

Facility(s) where procedure is performed (provide Account No. if applicable)

Facility Name

0 /

Facility Account No

0 /

Would you like to add another facility?

Facility Name (location 2)

0 /

Facility Account No (location 2)

0 /

Facility Name (location 3)

0 /

Facility Account No (location 3)

0 /

Practice Information (Location 1)

Location Name

Address

Address 2

City

State

Zip

Country

Practice email (for patient contact)

Practice Phone

Would you like to add another practice location?

Practice Information (Location 2)

Location Name

Address

Address 2

City

State

Zip

Country

Practice email (for patient contact at location 2)

Practice Phone

Would you like to add practice location #3?

Practice Information (Location 3)

Location Name

Address

Address 2

City

State

Zip

Country

Practice email (for patient contact at location 3)

Practice Phone

Additional Information

Languages Spoken (in addition to English)

0 /

Number of completed cases done using the Tenex Health TX System (for internal use only, must be >10 to be added).

Enter number

If less than 10 cases, provide reason for adding.

0 /

Upload Physician Headshot

(Upload high resolution file in jpg, png or gif format)

Upload

FormCraft - WordPress form builder

Use form below to add a physician profile to the Find-A-Doctor locator.

If you require additional assistance, contact:E: info@tenexhealth.comP: 949.454.7500

Doctor Finder Profile Form

If you require additional assistance, contact:
E: info@tenexhealth.com
P: 949.454.7500