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First Name

Last Name

Physician ID Number

Specialty

Sub Specialty

Board Certification

Area of Interest/Focus

Address

Practice Name

City

State/Province

Postal Code

Country

Telephone

Mobile Phone

Email Address

Secondary Email Address

Opt-In

By checking this box you are providing your Permission and Consent to use your PII (Personal Identification Information) in the manner as described on the HCP Registration Page

Please indicate which vertical you would like to receive information

Pharmaceutical

CME

Insurance

Publishing

Health & Wellbeing

Practice Based

Please indicate type of information

Brand Launch

New Indication

New Counter Indication

Clinical Trials

Patient Adherence

Technology/Tele Medicine

Tax/Insurance

EHR

Patient Care

Financial Planning

Medical Economics

HMO/PPO/Insurance

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Please note that by registering at the Proxima Platform HCP Registration Portal you are giving your individual permission and consent to either rent, license or sell your personal Identifiable Information (PII) which consists of the following. You are providing your individual Permission and Consent to have your PII (Personal Identifiable Information) to be used for 3^rd Party Promotional Messaging/Marketing and for 3^rd Party Data Transfer

Name, Postal Address, Email Address, Cookie, Telephone Number, Mobile Number, Fax Number, IP Address & Physician Demographic Data which includes but is not limited to: Primary & Secondary Specialty, Board Certification, Hospital & Practice Affiliation, Behavioral & Psychographic attributes to 3rd parties for marketing and promotional efforts.

To visit and review our GDPR Privacy Policy and to understand your Data Protection Rights please go here

HCP REGISTRATION PORTAL

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HCP REGISTRATION PORTAL