Professional Enrollment - Step 1 of 2

Professional Affiliates are healthcare professionals who are familiar with fertility awareness in general, and Ovusoft Fertility Software in particular. Becoming a Professional Affiliate tells Ovusoft users that you are supportive of their desire to understand their fertility by charting and are willing to review this information as part of their routine care.

If you are a doctor or nurse, you can sign up as a Professional Affiliate and get access to your patients' online WebCharts. You will also be listed in the Professional Referral Database so Ovusoft users in your region can find a Ovusoft-friendly provider.

Becoming a Professional affiliate is also free, fast and easy -- only two steps!

Please complete both the contact and practice sections.
All enrollments will be verified before being listed publicly.

Contact information: Please enter your own personal information here as you want it to appear in our practice referral system. Note that you will include the practice information in the next section.

indicates required fields

Salutation:

First name:

Middle name or initial:

Last name:

Title (MD, PhD, RN, etc.):

Sex:

Languages spoken (other than English):

Profession:

Specialty:

Personal email address:

Show email address in Professional Affiliate listing and within my message board profile

Add this email to news/updates mailing list

Enable private messsaging
Private messages are a feature of the Ovusoft Message Boards. If you check this box, patients and other Professional affiliates will still be able to contact you online, but your e-mail address will remain private (unless you have enabled others to see it above).

Comments (add anything you want potential patients to know about you):

Practice information: Please enter information about your practice here. If another professional in your practice has already signed up, simply select it from the list below and you will be added to it. Note that if you are adding your name to an existing practice that the creator of the original practice record will have to confirm your association with the practice before we can make your record public.

If you are adding your practice and your country uses zip/postal codes you should enter them, as this is a primary means of patients finding your practice when they search.

Select an existing practice:
To filter the list above, please select a filter method, the text to filter with, and click the "Filter" button below. After doing this, select the existing practice from the list above.
Filter practice list by:
Filter text:
Example: If you use "City" as the filter method and type "new" as the filter text, practices in New York, Newport News, New Haven, New Holland, etc. will be listed.

Enter practice name:
Address line 1:
Address line 2:
City:
State or Province:
Zip / postal code: (req'd for US, Canada, and UK)
Country:
Phone:
Fax:
Size of practice:
Web site address:
Practice email address
	Show email address in practice referral listing
	Add this email to news/updates mailing list
Comments (add anything you want potential patients to know about your practice):

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