Medical Website Design for Doctors

Connecting Your Practice to Our Patient Network - Millions Strong

From the Publishers of Healthy Living and Remedy and Healthcommunities' Network of Patient Websites

MDLocator/DPMLocator/VETLocator Enrollment

Contact person

Contact name:
Title:
Practice name:
Practice specialty:
Phone:	Ext.:
Fax*:
E-mail*:
Address:
City:	State: Zip:

Your name if different from above

Name:
Title:
Phone:	Ext.:
E-mail:

How Did You Hear About Us?

Web search: Google AOL Other search engine
Direct mail
Ad on a health information website published by Healthcommunities.com
Link from another website:
Referred by another practice:
Other:

Website link options

You do not need a website to be listed in MDLocator, but providing a link to more information on a practice website is the best way to achieve the full value of your listing.

Please select one:
Link to our current website:
Please create a basic one-page website for us, for an additional $2/month or $24/year.*
We do not have or want a website, but list our names, addresses, and main phone number in MDLocator.

*NOTE: Full-Service Medical Website Design is available separately. (Link opens in new window.)

Locations

We will list the doctors in your practice in MDLocator under all applicable zip codes. Therefore, providing an accurate and complete location list is important.

Please select one:
A complete list of our current locations is listed on our website.
We only have the location(s) listed below.
We will e-mail the complete list of locations later.
Some doctors only see patients at certain locations. We will e-mail the complete list later, indicating which doctors go to which locations.

Main address:
City:	State: Zip:
Phone:
Fax:
2nd address:
City:	State: Zip:
3rd address:
City:	State: Zip:

Practitioner Information

Practitioner Name (including MD, DO…)	E-mail Address	Primary Specialty (e.g., urology)	Board Certified

Billing Options

Please select one:
Yearly credit card
Monthly credit card
Yearly invoicing

We will send your bill or other payment information after we receive this enrollment form.

MDLocator Service Agreement

I have read and agree to be bound by the terms of the MDLocator Service Agreement.

Please save a copy of this completed form by printing this page now,
before clicking "Sign Up."

WHAT HAPPENS NEXT?

We will be in touch with you via e-mail to set up your billing.
If you ordered a one-page website, we will send you an e-mail with a preview.
We will list your doctors' names and locations in our online directory, with or without a website link, depending on your chosen options.
If, at any time, you wish to access our website development and marketing services, you can upgrade to the Full-Service Plan.

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Medical Website Design for Doctors

Connecting Your Practice to Our Patient Network - Millions Strong

From the Publishers of Healthy Living and Remedy and Healthcommunities' Network of Patient Websites

MDLocator/DPMLocator/VETLocator Enrollment

Please save a copy of this completed form by printing this page now, before clicking "Sign Up."

Please save a copy of this completed form by printing this page now,
before clicking "Sign Up."