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BoardCertifiedPlasticSurgeon.com (sm)
DIRECTORY APPLICATION Accepting only six plastic surgeons who must be good enough to PLEDGE Be Careful, Be Beautiful tm |
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BoardCertifiedPlasticSurgeon.com (sm)
DIRECTORY APPLICATION Accepting only six plastic surgeons who must be good enough to PLEDGE Be Careful, Be Beautiful tm |
We want only the BEST Plastic Surgeons for our Cosmetic Surgery Directory:
TOP surgeons who already have great web sites STILL list with us?
Find out why.
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BoardCertifiedPlasticSurgeon.com
Directory Application - MUST be acompanied by a signed and dated DIRECTORY PLEDGE (page 2) Page 1 of 2 Current Fee: Contact US Marion@BoardCertifiedPlasticSurgeon.com Payment to BoardCertifiedPlasticSurgeon.com by check, cashier's check or money order only! | ||||||||||||||||||||||||||||||||||||||||||
| Plastic Surgeon's name (as it appears on medical license): | ||||||||||||||||||||||||||||||||||||||||||
| Gender: male / female (circle one) State and MD Licence #: | ||||||||||||||||||||||||||||||||||||||||||
| List past and/or present licensure in other states or countries: | ||||||||||||||||||||||||||||||||||||||||||
| Name as it should appear on listing: | ||||||||||||||||||||||||||||||||||||||||||
| Practice name (if different than above): | ||||||||||||||||||||||||||||||||||||||||||
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Practice street address:
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| Practice City/Town/Zip Code: | ||||||||||||||||||||||||||||||||||||||||||
| URL (website address)_______________________________________________________ Use Website Photo? (Yes/No)______ | ||||||||||||||||||||||||||||||||||||||||||
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*Listing city/cities:
* Surgeons may request to be listed in a city, town or borough within a reasonable driving distance from their practice. | ||||||||||||||||||||||||||||||||||||||||||
| Specialty (check one or both): Cosmetic______ Reconstructive_______ | ||||||||||||||||||||||||||||||||||||||||||
Option: List total of 10 - 12 procedures frequently performed by you:
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| List Office Hours (if desired): | ||||||||||||||||||||||||||||||||||||||||||
| Contact person: ___________________________ E-Mail:_________________________________ Publish? Yes or No | ||||||||||||||||||||||||||||||||||||||||||
| Office Telephone:___________________________ Fax#_______________________________Publish Fax?_____ | ||||||||||||||||||||||||||||||||||||||||||
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Your current web site address: http://www.____________________________________
Web address will be listed but NOT be linked. We currently link only SPONSORS to their personal practice sites. | ||||||||||||||||||||||||||||||||||||||||||
| Month/Year Board Certified by American Board of Plastic Surgery or RCPSC: | ||||||||||||||||||||||||||||||||||||||||||
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Please mail completed, signed application and fee - payable to BoardCertifiedPlasticSurgeon.com:
BoardCertifiedPlasticSurgeon.com, PO BOX 442, Pittston, PA 18640. Terms
The terms of this agreement are for a limited time. The administrators of www.BoardCertifiedPlasticSurgeon.com reserve the right to change any and all terms and agreements without prior notice, and at our sole discretion. We also reserve the right to refuse to list any applicant, or to remove a listing, subject to a refund as set forth above, for any reason at any time, at our sole discretion. Please note that our administrators may check with applicable state Board of Medical Examiners/Board of Medicine to verify certain credentials. Thank you.
Copyright 2008 - 2012 by BoardCertifiedPlasticSurgeon.com (sm) All Rights Reserved | ||||||||||||||||||||||||||||||||||||||||||
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BoardCertifiedPlasticSurgeon.com (sm)
Directory Pledge Prior to listing, all board-certified plastic surgeons MUST read, accept and sign this Directory Pledge. This is page 2 of the application process. Page 1: Directory Application. RENEWING SURGEONS: our Directory Pledge must be signed each year upon renewal. |
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Signature:____________________________________________Date Signed:_______________ DIRECTORY PLEDGE "By signing the above, I am stating that I am board-certified in plastic surgery by the American Board of Plastic Surgeons or the Royal College of Physicians and Surgeons of Canada, that my medical license in the state where I am practicing is current and has not been revoked (nor has it been revoked in any other state), and that I am not currently being investigated or disciplined for medical malpractice, or being considered for discipline for medical malpractice, by the Board of Medical Examiners of any state or country, nor has any Medical Board or comparable supervisory board deemed it necessary to bring disciplinary action against me in the past 5 years of longer. I further state there have been no malpractice judgments or settlements against me for a minimum of 5 years. I also promise to inform, immediately, the webmaster of www.BoardCertifiedPlasticSurgeon.com if the status of any of the above specifications have changed at any time during my listing period. I understand that listing on BoardCertifiedPlasticSurgeon.com is at the sole discretion of the webmaster of BoardCertifiedPlasticSurgeon.com, I understand that my listing on BoardCertifiedPlasticSurgeon.com may be removed, and the remainder of the unused subscription fee, at a pro-rated monthly basis, up to 6 months, will be refunded to me. I agree with these terms and also agree not to take any legal action, and agree to forfeit the right to any and all legal action, against the webmaster or administrators of www.boardcertifiedplasticsurgeon.com for the removal of my listing." |
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Please mail this dated and signed Pledge and Directory Application with relevant fee payable to:
BoardCertifiedPlasticSurgeon.com, PO BOX 442, Pittston, PA 18640. Terms
The terms of this agreement are for a limited time. The administrators of www.BoardCertifiedPlasticSurgeon.com reserve the right to change any and all terms and agreements without prior notice, and at our sole discretion. We also reserve the right to refuse to list any applicant, or to remove a listing, subject to a refund as set forth above, for any reason at any time, at our sole discretion. Please note that our administrators may check with applicable state Board of Medical Examiners/Board of Medicine to verify certain credentials. Thank you.
Copyright 2008 - 2012 by BoardCertifiedPlasticSurgeon.com (sm) All Rights Reserved |
Learn more about our Directory: Plastic Surgeon Directory Information
CONTACT US or learn more ABOUT US
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