HCQ Doctor Network

Dear medical professional, thank you for taking the time in completing the form below. Your FREE listing in our HCQ Doctor Network will save lives and educate individuals on treatment of the COVID-19 illness. Upon submitting this form, your profile listing will be found under the “Doctors” tab above.

First Name

Last Name

Email (internal use)

Phone Number

Address

Address Line 1

Address Line 2

City

State

Zip Code

Country

Medical Field of Practice

How many years in practice?

Approximately how many COVID-19 patients have you treated?

Do you have a website?

Yes

URL

Social Media Reference

URL

Physician Image Upload

Choose File

By submitting this form, you agree to be listed in our network as an HCQ treatment doctor. All information obtained is strictly used for the profile listing only. You may be removed from the listing upon contacting us by email.