Welcome to Samaritan!

The New Physician Reception is an opportunity to welcome new physicians recruited throughout the year and provides the medical staff the chance to get to know each other socially. We also recognize our new Advanced Practice Providers (APPs) at this event.

As a guest of honor at the reception scheduled for Monday, October 19, 2026, beginning at 5:30 p.m. we ask you to complete the questionnaire below by September 22, 2026, so we can create a poster about you to showcase at the event. We will ask that you RSVP for the event after the invitation is mailed out.

If you have any questions about the questionnaire form, you can contact Leslie DiStefano at [email protected] or 315-785-4504.

New Physician Reception Questionnaire

Samaritan’s New Physician Reception. October 19, 2026 – 5:30 p.m. Samaritan Summit Village

Name(Required)

First Middle Last

Specialty:(Required)

Practice Name:(Required)

Board-certification:

Specific medical areas of interest and/or additional training:(Required)

Procedures you specialize in or want others to know you perform:(Required)

Spouse's / Significant other's name (if applicable):

Children's names and ages (if applicable):

Hometown:(Required)

Last place you lived:(Required)

Hobbies:

Fun fact about you and/or your family:

Use the box below to upload 3 to 4 photos of you/your family:

Drop files here or

Max. file size: 512 MB, Max. files: 8.

Welcome to Samaritan!

New Physician Reception Questionnaire

You are now leaving samaritanhealth.com