US PLASTIC SURGEONS®™
Physician Information Request Area
If you are an excellent plastic and/or cosmetic surgeon who is interested in growing your practice by operating on more patients, then USPS Membership is for you. To request full details regarding USPS Membership enrollment and its accompanying patient referral program simply complete the short form below. 		USPS Member services include:
New patient referrals
Practice Web development
Practice directory listings
Search engine optimization (SEO)
Medical press releases
Internet product marketing
and much more (read below).

PLEASE NOTE: You must be the physician to submit this information request.
Please complete the information request form below:
Physician full name
Board certification(s)
Board certification date(s)
E-mail address
E-mail address reconfirm
E-mail to which you wish us to send your patient referrals
Practice address
City
State
ZIP
Practice telephone    Example: (Area Code) 555-1212
Cellular telephone   
Practice Manager   
Patient Coordinator
Practice Web site(s)
SELECT INFORMATION ABOUT SERVICES FOR YOUR PRACTICE BELOW  (check all that apply)

I would like information about receiving the following number of new patient referrals:
100 patient referrals
200 patient referrals
300 patient referrals
400 patient referrals
500+ patient referrals

  In addition to patient referral services, I am also interested in:
A new practice Web site with free design and hosting
Search Engine Optimization for my current Web site (so that patients can find it)
Adding video and other multi-media to my Web site to enhance viewer experience
Banner advertising for my practice on multiple top plastic surgery Web sites
Internet marketing and press releases for my practice's products and services
Publishing my articles about cosmetic surgery on top plastic surgery Web sites
Finding a new patient financing company
All of the above
Another service not listed above (please specify below):
 

Press the SEND REQUEST button below to submit your information request.

                                                                                  

US Plastic Surgeons®  ©1996-2009