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PBHS - A RevenueWell Company
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PBHS Directory Questionnaire
Get Started Today
PBHS Directory Questionnaire
Your Name
Your Society Website Address
Your Email
What is the reason for adding a doctor directory to your site?
For doctors to find each other
For patients to find a doctor
Other
If other, please describe
What pages on your website would you like the membership list and new registration form to appear on? By default we usually create two new pages for these items, "Membership List" and "Become a Member".
Once somebody fills out the "Become a Member" form, what email address would you like the form to be sent to?
For each member display (if available):
Practice Name
Office's Email
Office's Phone Number
Office's Fax
Doctor’s Degree
Doctor’s Email
Doctor’s Phone Number
Users Fax Number
How would you like to display your members?
By Company
By User
Do you have multiple addresses for your doctors?
Yes
No
Please complete the attached spreadsheet for member listing information and email the completed spreadsheet to your account manager.
Download Society Member Format - Multi-Office
Please complete the attached spreadsheet for member listing information and email the completed spreadsheet to your account manager.
Download Society Member Format - Single Office
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