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.

As a guest of honor at the reception scheduled for Tuesday, November 14, 2023, we ask you to complete the questionnaire below by October 6, 2023. We will ask that you RSVP fr the event after the invitation is mailed out.

If you have any questions about the questionnaire form, you can contact Leslie DiStefano at ldistefano@shsny.com or 315-785-4504.

New Physician Reception Questionnaire

Registration for Samaritan’s New Physician Reception. Date: November 14, 2023.

Name

First Last

Specialty:

Practice Name:

Medical School:

Residency:

Fellowship(s):

Board-certification:

Specific medical areas of interest:

Additional training in:

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

Spouse's / Significant others name:

Children's names:

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: 256 MB, Max. files: 4.