Welcome to SIU Medicine!

Please fill out this form to provide the marketing team information for your online profile.

These profiles will be display on one or both of our websites; www.siumed.org (patient audience) and www.siumed.edu (learner audience). Therefore, it is important you fill this out as detailed as possible to provide your information and specialties to the correct audience. We will filter information based on the audience.

Please reach out to us with any questions.

Are you a new or current SIU employee
Tell us about your work here (check all that apply)
Gender
Prefix
This is typically Associate Professor or Assistant Professor - if you do not have a faculty appointment, please leave this field blank.
BILLING PROVIDERS ONLY: This is the title you give patients. For example: family medicine physician or registered dietician or pediatric surgeon
List as degree, name of school, city
BA, University of Illinois, Urbana, IL
List as degree, name of school, city
MBA, University of Illinois, Urbana, IL
Lis as name of school, city:
SIU School of Medicine, Springfield, IL
List as residency program, name of school, city:
Family Medicine, SIU School of Medicine, Springfield, IL
List as fellowship program, name of school, city:
Neurosurgery, SIU School of Medicine, Springfield, IL

Specialty

Below is a list of specialties. Please select all that apply 

Select all that apply
Specialty

Treatments

Click here to view treatments and type all that you provide in the text area below

Provider Portrait

Click here to schedule your professional portrait with the SIU Medicine photographer in Springfield