Peds on Call | Ohio AAP

First Name *

Last Name *

Practice Name

Area of Practice: PCP, Sub-Specialist (if yes, what area?)

Are you an expert in an area of child health? *

Yes

If so what area?

Phone (Cell/Home/Office)

Is Phone Number

Cell

Home

Office

Phone Number for Texting

Email Address *

Preferred Method of Contact *

Phone (Cell/Home/Office)

Phone Number for Texting

Social Media Used *

Instagram Handle

Twitter Handle

Other Social Media Handle

Interest Area (DISCLAIMER: These are current issues on the advocacy agenda for the Ohio AAP. Click the link below for a full list of advocacy initiatives.) *

Advocacy Goals

Who is your Ohio state Representative? *

Who is your Ohio state Senator? *

Find My Legislator

Disclaimer *

I attest that I am a current member of the Ohio Chapter, American Academy of Pediatrics (Ohio AAP) and are joining Peds On Call because I support the Chapter’s mission and advocacy position on immunizations, injury prevention, mental health, healthy weight and nutrition and all other child health topics. I agree that this group is a member benefit of Chapter members only, and therefore I will not share private member only documents, either electronically or verbally, that I receive from Peds on Call via email, social media platforms or verbal conversations as it is a violation of our Chapter bylaws. Please note, any person(s) that misrepresent their identity, Ohio AAP membership status and/or medical credentials will be held accountable in a court of law.

What is Peds on Call?