Physician Survey Form

We offer this Directory as a resource to women and couples who seek physicians practicing medicine in accord with traditional Christian principles. The physicians listed in this directory do not prescribe, perform, or refer for contraception, sterilization, abortion, or in vitro fertilization.

In order to be able to confidently refer individuals or couples to physicians who subscribe to these values, we ask physicians to complete this online survey detailing their stance on issues of contraception, sterilization and abortion. Those physicians who qualify, and who gave us permission to use their names are included in this Directory.

1. About Yourself
2. Contact Information
3. Survey
  1. I do not and will not prescribe or refer for hormonal contraception
  2. I do not and will not prescribe or refer for barrier forms of contraception
  3. I do not and will not perform or refer for abortion
  4. I do not and will not perform or refer for sterilization
  5. I do not and will not perform or refer for in-vitro fertilization
  6. I am familiar with Natural Family Planning
  7. I do promote abstinance for my young and/or unmarried patients
  8. I will promote breastfeeding for healty moms and babies
  9. I am qualified and willing to perform sterilization reversals for men
  10. I am qualified and willing to perform sterilization reversals for women
  11. (If applicable) I am willing to reduce my fee for sterilization reversals as a ministry to those who desire to follow God's Will in this area
4. Questions for NFP-Only Medical Professionals
  1. I have used NFP/NPT* based medical procedures to treat patients for infertility and other reproductive system disorders.
  2. I have conducted or currently conduct medical research on the development and application of NFP/NPT*
5. Agreement
  1. I confirm that all the above information is correct and give One More Soul permission to publish this information in their NFP-Only Medical Professionals Directory and at their website (http://onemoresoul.com)
 

cforms contact form by delicious:days