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) as well.

As a guest of honor at the reception scheduled for Wednesday, October 29, 2025, beginning at 5:30 p.m. we ask you to complete the questionnaire below by October 3, 2025, 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 Anna Doldo at [email protected] or 315-785-4584.

New Physician Reception Questionnaire

Samaritan’s New Physician Reception. October 29, 2025 – 5:30 p.m. Samaritan Summit Village

Name

First Middle Last

Specialty:

Practice Name:

Board-certification:

Specific medical areas of interest and/or additional training:

Procedures you specialize in or want others to know you perform:

Spouse's / Significant others name:

Children's names and ages (if applicable):

Hometown:

Last place you lived:

Hobbies:

Fun fact about you/family:

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

Drop files here or

Max. file size: 2 GB, Max. files: 8.

Welcome to Samaritan!

New Physician Reception Questionnaire

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