Physician Email Collection Form for Official Ascension Seton Communications


*First Name:

*Last Name:

*Email Address:  

Is this a new email address?: Yes No

*Date of birth (mm/dd/year):

*TX State Medical License #:
(for identification verification)

Optional E-mail Communications

This is a list of completely optional email communications that you may wish to receive in addition to the official Ascension Seton emails. In order to keep the file size down the majority of these items would consist of little more than a brief introduction along with a link to guide you back to the corresponding material on DoctorLink.


If you wish to answer yes or no for all of the following options you may do so by indicating your preference here. Otherwise, please indicate your preference for each offer individually.

I wish to opt-in to all of the following notifications.

I wish to opt-out to all of the following notifications.


Medical Record Delinquencies

Placement on Site-Specific Suspension

Placement on Network-Wide Suspension

The availability of the most recent publication of the Ascension Seton Medical Staff Newsletter on DoctorLink

CME Opportunities

Private-Practice Related Educational Opportunities

New Ascension Seton Site, Clinic or Group Openings & Updates

New Technologies/Services within the Ascension Seton Network

New on-line tools available on DoctorLink

Physician Community Events-for Physicians only (eg., Catholic Physicians Guild, Pediatric Alliance of Central Texas, etc)

Upcoming Events and News (maximum of once a week)


Frequently the Network Medical Staff Office will receive a request to share the email addresses of individual physicians so that the requester may contact them personally. We will not share your email unless you have specifically given us permission to do so. Reasons often voiced along with these requests include such things as committee communications, medical directors seeking physician input, and peer to peer referral. Please indicate your email sharing preferences below.

My email may be shared with all of the following sources/individuals.

I do not wish my email to be shared under any circumstance.

Yes No

Ascension Seton Medical Directors

Elected Officers of the Ascension Seton Medical Staff (Chief of Staff, Committee Chairs, etc.)

Health Information Management (Medical Records)

Compass Support Team

Ascension Seton Medical Staff Members