Sign up for COMPLEMENTARY staff education from Physician’s Weekly and patient exam room education through Healthy Living by Physician’s Weekly  

Contact Information

Name*

Practice Specifics

Practice Name*
Mailing Address*

Location Details

Staff Area where you will display Physicians’ Weekly content, i.e., break room, nurses station, medical sample area, etc.?*

Note: When Healthy Living patient exam room posters are available, we send 3 copies

Physicians/Clinicians

Please list any physicians or clinicians at your practice.

Do you have additional locations where you would like to receive free copies of Physician’s Weekly/Healthy Living Patient Education from Physician’s Weekly? If so, please provide the Facility Name, Address and Contact Name/Number

 

Note: If at any point in time you don’t wish to receive Physician’s Weekly staff education or Health Living Patient Education please let us know.