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My Kind of Medicine: Real Lives of Practicing Internists Profile Request Form

Each month, in our Medical Student Member newsletter, IMpact, the My Kind of Medicine article features the career of an internal medicine specialist or subspecialist. These stories about positive role models help to inspire students to pursue careers in internal medicine. Share your story -- or recommend a colleague's story -- today. Selected physicians will be interviewed by ACP staff and profiled in an upcoming issue.

Contact Information

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Name:*
Job Title:*
E-Mail:*
Phone Number:*
ACP Number:

Would you like to share your own story? * Yes No
If yes, please briefly tell us a little bit about your career:

Would you like to see a colleague or mentor profiled? * Yes No
If yes, please provide the following information for your colleague or mentor:

Name:
Job Title:
E-Mail:

Please briefly tell us why you would like to see this person featured in IMpact:

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