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Association of Women for the Advancement of Research and Education




Recommend Your Healthcare Provider

Complete this form to recommend your healthcare professional (doctor, nurse, naturopath, other) and tell us why.

Names and contact information can be listed—at no charge—on ProjectAWARE's Patient Preferred Provider page. Aside from being listed on our Provider pages you can be assured that we never disclose or use your name, email address or other information at any time for any other purpose without your permission.

We respond to every email we receive, so if you don't hear from us within 2 weeks, please contact us again. Perhaps something went wrong with a server somewhere...

Fill in the blanks and click on the "Submit" button.  * =Required

Name being recommended: * Credentials *
Address: *
City: * State/Prov: *
Country: Zip code/Postal code: *
Telephone: * Fax:
Provider Email: * Email verify:
Speciality: *
Recommended by: * Recommender Email: *


Please help us prevent spam by entering both verification words below:  *



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