Join MD+ | Member Intake Form

1. About You

Let us know who you are and how we can reach you.

or enter details manually

First Name

Last Name

Primary Email Address

Institutional Email (optional)

School or medical institution email

Personal Email (optional)

Personal email address

Secondary Emails (optional)

Comma-separated emails to also receive community updates

Create Password

Confirm Password

Phone (optional)

Location (optional)

LinkedIn URL (optional)

How did you find out about us? (optional)

2. Academic & Clinical Background

Tell us about your medical training and clinical journey.

📋 Community Background Note

MD+ is dedicated to clinicians and aspiring physician-innovators (medical students, residents, fellows, and physicians). Information provided here is used to match you with peers and relevant mentors.

Current Institution

Primary Degree

Training Stage

Additional Degrees (optional)

Select any additional degrees or dual degrees you hold

Undergraduate Information (optional)

Where did you complete your undergraduate studies?

Are you practicing clinically right now?

YesNo

Can you briefly explain why? (optional)

I confirm that I am a Medical Student (MD, DO, MBBS, or equivalent), Resident, Fellow, or Physician.

3. Interests & Goals

Tell us what topics excite you and what you hope to explore.

What areas interest you? *

Select the pathways that spark your curiosity. This helps us connect you with the right circles.

✍️ Quick Thoughts Welcome!

Don't worry about long essays or perfection. Quick thoughts, bullet points, or informal ideas are completely fine. We just want to get to know you!

What do you want to learn or explore in MD+? (optional)

What drew you here? What are you hoping to gain?

What perspective or skills would you like to share? (optional)

Experiences or topics you enjoy discussing with peers

How does MD+ fit into your journey? (optional)

How this community aligns with your goals

Are you interested in mentoring or being mentored? (optional)

Tell us if you'd like to mentor students or find a mentor in a specific vertical

4. Resume / CV & Overview (Totally Optional)

Upload your resume or CV if you have one handy, or feel free to skip.

Click to upload or drag and drop

PDF, DOC, or DOCX (max 10MB) — completely optional

Intake Overview

Name—

Email—

Institution—

Stage & Degree—

📬

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