Application Form

We are currently accepting US and Canadian physicians with active and current valid state medical licenses. International physicians can be accepted on a case by case basis, email cfipphysicians@gmail.com before applying. Medical licenses currently accepted are Medical Doctor and Doctor of Osteopathy.

Personal Information

Name(Required)

First Last

Personal Email(Required)

Enter Email Confirm Email

Office Email (Optional)

Office Phone (Optional)

Personal Information

Current Position/Title(Required)

Medical Specialty(Required)

Focus of Functional/Integrative Medicine Practice(Required)

Workplace/Institution(Required)

Practice Website (if applicable)

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Years in Practice(Required)

Years Practicing Functional Medicine(Required)

Educational Background

Residency Program

Fellowship Program (if applicable)

Integrative or Functional Medicine Training and Certifications (if applicable)

Please list any training you have completed in Functional and/or Integrative Medicine. This is not required for membership

Licensure and Certifications

If you have multiple state licenses please upload the one license from your current state of practice. This is simply for documentation of your degree. Additional licenses can be updated to complete your online profile at a later date.

Medical License Number(Required)

State of Licensure(Required)

Membership Details

Would you like to be included in the searchable Public Directory?(Required)

Yes

Membership Category(Required)

How Did You Hear About Us?

Supporting Documents

Upload Medical License(Required)

Max. file size: 500 MB.

Upload Functional Medicine Certifications (Optional)

Max. file size: 500 MB.

Personal Statement

Are you currently an active participant in MD/DO Lounge?(Required)

Yes

What is your MD/DO Lounge Name?

What are your primary interests for joining CFIP?(Required)

Which committees are you interested in participating in?

Library/Best Practices Committee: Create evidence-informed resources

Membership and Communications Committee: Membership criteria, Website and internal communications

Education Committee: Outward facing education

Events Committee: Plan organizational events

Mentorship Committee: Establish direct clinical mentorships

Agreement and Submission

Consent(Required)

Welcome to the College of Functional and Integrative Medicine Physicians (CFIP) website!

These Terms & Conditions ("Terms") govern your access to and use of the CFIP website located at https://www.cfip.co (the "Site"). By accessing or using the Site, you agree to be bound by these Terms. If you disagree with any part of the Terms, then you may not access or use the Site.

1. Acceptance of Terms

These Terms constitute a legally binding agreement between you ("you" or "User") and CFIP ("we" or "us"). You acknowledge that you have read and understood these Terms, and agree to be bound by them and all applicable laws and regulations.

2. Content Ownership

The content on the Site, including text, graphics, logos, images, and other materials ("Content"), is the property of CFIP or its licensors and is protected by copyright and other intellectual property laws. You may not use any Content on the Site without our prior written permission.

3. Use of the Site

The Site is provided for your informational purposes only. You may not use the Site for any unlawful purpose or in any way that violates these Terms.

4. Disclaimers

The information provided on the Site is for general informational purposes only and does not constitute medical advice. You should not rely on any information on the Site as a substitute for professional medical advice, diagnosis, or treatment.

5. Third-Party Links

The Site may contain links to third-party websites or resources. These links are provided for your convenience only and we do not endorse the content of any such third-party sites.

6. Limitation of Liability

CFIP shall not be liable for any damages arising out of or related to your use of the Site.

7. Termination

We may terminate your access to the Site at any time, without notice, for any reason, including, but not limited to, your violation of these Terms.

8. Governing Law

These Terms shall be governed by and construed in accordance with the laws of the State of [State], United States of America.

9. Entire Agreement

These Terms constitute the entire agreement between you and us regarding your use of the Site.

10. Changes to the Terms

We may revise these Terms at any time by updating this page. You are bound by any revisions and should therefore periodically visit this page to review the current Terms.

11. Contact Us

If you have any questions about these Terms, please contact us.

I agree to the terms & conditions.

Code of Conduct(Required)

Welcome!

This code of conduct outlines the expectations for respectful and productive interaction within our community (website, forum, event, etc.). By participating, you agree to these guidelines.

Respect and Courtesy:

Treat all participants with respect, regardless of background or beliefs.
Be mindful of your language and avoid offensive or discriminatory comments.
Disagreements are okay, but maintain a civil and professional tone.

Content and Conduct:

Share information that is relevant and contributes to the community's purpose.
Avoid posting spam, advertisements, or irrelevant materials.
Do not engage in personal attacks, harassment, or bullying.
Report any inappropriate behavior to the moderators/administrators.

Safety and Privacy:

Protect your own privacy and avoid sharing sensitive personal information.
Do not share private information about others without their consent.
Report any suspicious activity or potential security breaches.

Consequences:

Violations of this code of conduct may result in warnings, temporary bans, or permanent removal from the community.

We reserve the right to update this code of conduct at any time.

Thank you for helping us create a positive and inclusive environment!

I agree to the terms & conditions.

Membership Fee

Price:

Coupon

Total

Credit Card(Required)

Signature(Required)

This field is for validation purposes and should be left unchanged.

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