The Online Enrollment Form

Today is the day to advertise your Practice on Collierdocs.com and join fellow Medical Professionals who are enjoying the benefits of national visibility on the most powerful online Medical Service Directory in Florida.

To take advantage of the enrollment special of $150.00  with no set-up fee, simply complete this online listing request form. By completing this online form you will be under no obligation to enroll with Collierdocs until you are completely satisfied, and only after your review and release will you be invoiced. Collierdocs.com is a member of The Naples Area Chamber of Commerce.

Please answer all questions as completely as possible, the more detail, the better your listing will look to the Collier County public. We will also need a quality photo of you from the waist up or thereabouts that we can take or you can mail to:

Collierdocs, P.M.B. 186
3823 Tamiami Trail East
Naples, Fl 34112

We will scan it and send it back to you. You can also email a digital photo to us at info@collierdocs.com

If you have any questions about this form please call Collierdocs Customer Service at 1-888-740-3917.

 		    

Name and Practice or Clinic Name

Business Street Address

City -State -Zip Code

Telephone

Fax

Email Address


Qualifications: Board certifications, Fellow of Academy, Medical/Dental School, internship/ residency locations, special appointments/achievements, length of time practicing total and while in Collier county.

Services: Information about your practice specialties, such as, various procedures you offer, exams you perform, consultations, and continued care.

Insurance Programs You Accept: List all insurance plans your practice is qualified to accept: such as Collier County PHO, other PPO, HMO or private plans.

Special Features: Office details, special well/sick exam rooms, on site pharmacy, X-ray, lab work, accept new patients, office hours of service, can you be seen for urgent care cases during non-business hours, your office email address and the URL of your web site if you have one (it is not necessary to have a web site to be listed on Collierdocs.com).