Form – Physician Newsletters

Newsletter Service Onboarding

Welcome! This form takes 15-20 minutes to complete.

You’ll only fill this out once—future newsletters use a quick 5-minute form.

Practice Information

Practice Name *

Your Name & Credentials *

Medical Specialty/Focus *

Practice Type *

Practice Website

Main Office Phone Number *

Used in newsletter CTAs when patients need to schedule appointments

Years in Practice *

Patient Demographics & Community

Primary Patient Age Range *

Select all that apply

Children (0-12)

Teens (13-17)

Young adults (18-35)

Middle-aged adults (36-55)

Older adults (56-70)

Seniors (70+)

Geographic Location *

Helps us reference local health concerns, seasonal issues, climate

Practice Setting *

Communication Style & Tone

Preferred Newsletter Tone *

Writing Voice Preference *

First person (“I recommend…” / “In my practice…”)

First person plural (“We recommend…” / “Our practice…”)

Educational third party (“Physicians recommend…” / “Research shows…”)

Most physicians choose “first person plural” as it feels personal while representing the entire practice team

Voice & Style Notes

Content Focus & Priorities

Top 5-7 Health Topics Your Patients Ask About Most *

List the conditions, symptoms, or health concerns that come up most frequently in your practice

Seasonal or Timely Topics Relevant to Your Practice

Health issues that peak at certain times of year in your practice

Services or Procedures You Want to Educate Patients About

New services, underutilized services, or procedures patients often have questions about

Topics to AVOID

Health topics outside your scope, controversial in your community, or that you prefer not to address

Patient Engagement Goals

Primary Goal for Newsletter Program *

What Do You Want Patients to DO After Reading? *

Select your top 3 priorities

Schedule routine/preventive appointments

Call with questions or concerns

Visit practice website for more information

Follow practice on social media

Implement health tips and lifestyle changes

Book specific services (screenings, procedures)

Refer friends and family

Download resources from website

Current Patient Engagement Challenges

Practice Updates & Recurring Content

Do You Have Regular Practice News to Share? *

Yes, we frequently have updates (new staff, services, hours, etc.)

Occasionally (a few times per year)

Rarely – focus newsletters primarily on health education

Types of Updates You’ll Want to Include

Select all that apply

New staff introductions

New services or equipment

Office hour changes

Seasonal appointment reminders (flu shots, physicals, etc.)

Community events or health fairs

Practice achievements or recognition

Staff spotlights or “meet the team” features

Standing Practice Information

Information we should have on hand to reference when relevant

Compliance & Restrictions

HIPAA & Privacy: Newsletters will NOT include patient names, photos, testimonials, or case studies unless you explicitly provide written permission for each instance.

Regulatory or Legal Restrictions

Any regulatory bodies, hospital systems, or legal restrictions that govern your practice communications

Medical Board or Specialty Organization Guidelines

Any professional organization guidelines we should be aware of

Technical Details

Newsletter Distribution Method *

Current Email List Size (approximate) *

Newsletter Send Day Preference *

We’ll deliver completed newsletters 3-4 days before your preferred send day

Partnership Level

Service Tier *

Professional Service ($997/month) – Form-based, email support, 48-hour delivery

Custom Partnership ($2,497/month) – Monthly strategy calls, unlimited revisions, voice matching

Best Email for Newsletter Communication *

Backup Contact

Name and email of someone who should be copied on communications

Inspiration & Examples

Are There Health Newsletters or Communicators You Admire?

What Do You LIKE in Patient Communications?

What Do You DISLIKE in Patient Communications?

Additional Information

Is There Anything Else We Should Know?

How Did You Hear About Us? *

Next Steps

After you submit this form:

Professional Service: We’ll send your first newsletter topic suggestion within 48 hours. You’ll confirm or adjust using the bi-weekly submission form.
Custom Partnership: We’ll schedule your onboarding strategy call within 3-5 business days to review this information and plan your first quarter of newsletters.
First Newsletter: Your first newsletter will be delivered within 7 business days of completing onboarding.
Bi-Weekly Rhythm: Starting with newsletter #2, you’ll receive a simple 5-minute form every two weeks.

Questions about this form? Email support@physiciannewsletters.com

All information is confidential and used solely to create your newsletter content.