Collaborative Care Members in Practice - Are you the First Collaborative Care Member Making Application?* (Select One) I am the FIRST Collaborative Care Member in My Practice to Make/Renew Application to the RSA. (inclusive of OD’s, NP’s, RN’s, and/or PA’s) I am NOT the FIRST Collaborative Care Member in My Practice to Make/Renew Application to the RSA. (inclusive of OD’s, NP’s, RN’s, and/or PA’s)
Example:
……….One (1) Collaborative Care Member - $500
……….Two (2) Collaborative Care Members - $750 ($250 each Additional CC Member)
……….Three (3) Collaborative Care Members - $1,000 ($250 each Additional CC Member)
……….Four (4) Collaborative Care Members - $1,250 ($250 each Additional CC Member)
……….Etc…
Credentials* Please include here the Credentials which will follow your name on your Member Page.
Certifying Board*
Please provide the name of the board which awarded your certification(s). i.e. ABO for American Board of Optometry. Enter "Board-Eligible" if you have not yet taken your boards or enter the certifying body from whom you are certified/eligible to be certified.
Year Board Certification*
If you are "Board Eligible", simply include the year you anticipate taking your boards. If you selected "Neither" or "Other" enter N/A.
Tell us about yourself...* Please describe your practice and your interest in the Refractive Surgery Alliance Society.
Biography (Not your CV)* Members receive a "Member Bio Page" on the Refractive Surgery Alliance website, among other things. Please provide a short biography about yourself to be included on your RSA Member Page upon approval of your application for membership. This will serve as an introduction to web site visitors. Please use "third person" in writing style. (i.e. Mary Jones, OD is the Managing Director of World Pharmaceuticals headquartered in Bern Switzerland. Dr. Jones is a graduate of...)
This page provides potential patients with an insight into your personal approach to refractive surgery. It should reflect your passion, your philosophy and your purpose. It should NOT repeat what is published on your practice web page, but should speak directly to patients as if they met you in your office. Sterile content about your professional background is not as compelling as statements about your commitment to helping them achieve their goals in pursuit of better vision.
The following general format may be appropriate – this is your page so make it what you want it to be:
Paragraph 1: Who you are, where you serve, why you practice.
Paragraph 2: What a patient can expect from the professional services you provide.
Paragraph 3: What motivates you to practice in the field of vision correction services for refractive surgery?
Paragraph 4: Credentials/Training/Positions/Accolades/Areas of Professional Expertise and Interest.
Paragraph 5: Any personal information you may want to divulge (family, hobbies, charity work, etc.)
Maximum character count 3000.
Additional Comments (Optional) Please provide any other information you would like considered with this RSA Membership Application.