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Create Profile First Name * Last Name * Email Address * Username (lowercase alphanumeric) * Password (type this twice please) * password strength indicator Additional Info Salutation (Dr, Miss, Mrs, Mr, Professor, etc.) * Contact Details Professional Initials Title/Position Professional Specialty * OtherRTRNNPMDBreast SurgeonFamily DoctorGynocologistMedical OncologistPathologistPlastic SurgeonRadiologist Department Facility Name * Facility Street Location Address * Facility Mailing Address if different from Street Address City * State * Zip * Country * Home Address Street Home Address City Home Address State Home Address Zip Home Address Country Business Numbers for General Public/Clients Voice * Fax Website Direct Numbers of Applicant Voice Fax Email Identify area(s) about which you would be willing to share your expertise (Hold control key down to select more than one) -- Select Here --Policy and Procedures ManualStaff Roles and Job DescriptionsAdministrative SoftwareTracking SoftwareBreast Center Physical SettingsStarting a Breast CenterExpanding a Breast Center to a Women's CenterMarketing TechniquesMachinery and EquipmentPurchase/FeasibilityMerging Facilities/Buyouts - Patient ImpactMerging Facilities/Buyouts - AdMinistrative/Operation ImpactClinical Pathway DevelopmentMobile MammographyPatient Educational ResourcesLymphedema ProgramsHigh Risk ProgramsOutreach ProgramsClinical TrialsBreast ReconstructionBreast AugmentationNutritional Counseling/InformationPsycho-social services/programs Patient Services - This information will appear on your Internet Listing Mobile Mammography (Hold control key down to select more than one) -- Select Here --ProvidedNot provided Number of units (sites) Self-Referrals Accepted (Hold control key down to select more than one) -- Select Here --YesNo Diagnostics (Hold control key down to select more than one) -- Select Here --Fine needle (FNA)Core biopsyUltrasoundStereotacticGalactographyScintimammographyOsteoporosis testingMRI Guided Needle Biopsy Rehabilitation (Hold control key down to select more than one) -- Select Here --Lymphedema programPhysical TherapyProsthesis Fitting Other services for women offered on site (Hold control key down to select more than one) -- Select Here --Coordination of pre-natal servicesCoordination of ob/gyn servicesCoordination of osteoporosis servicesCoordination of preventative servicesParticipate in clinical trials Interdisciplinary Breast Team (Hold control key down to select more than one) -- Select Here --Hold Multidisciplinary Breast ConferenceHolds Weekly Prospective Breast ConferenceHas Certified Breast Patient Navigator On SiteHas Certified Clinical Breast Examiner On Site Certifications/Accreditations (Hold control key down to select more than one) -- Select Here --NQMBCNAPBCBICOE Treatment (Hold control key down to select more than one) -- Select Here --ChemotherapyRadiation therapy Patient Education (Hold control key down to select more than one) -- Select Here --High Risk counselingPatient Resource literaturePatient Resource library/dedicated areaComplementary and Alternative medicineLife StylesNutrition counselingPsychosocial counselingPatient educator on staffPatient Advocacy and Survivorship GroupsCoordinate Social Service options for patients Surgical (Hold control key down to select more than one) -- Select Here --Reconstructive surgeryCosmetic SurgerySentinel Lymph node mapping and biopsyDuctal Lavage for high risk women Business Description Please provide a description of your business. 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