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 Thursday, November 7, 2024, we ask you to complete the questionnaire below by October 4, 2024. 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. November 7, 2024 from 6 – 9 p.m.

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: 2 GB, Max. files: 4.

Welcome to Samaritan!

New Physician Reception Questionnaire

You are now leaving samaritanhealth.com