Get Ama Profile

Filling out the Ama Profile is a straightforward process that allows physicians to request their profiles efficiently. This guide provides comprehensive steps to help you complete the form accurately and efficiently.

Follow the steps to complete the Ama Profile form

1. Press the ‘Get Form’ button to access the form and open it in an editor.
2. Indicate your AMA membership status by checking either the 'Member Physician' or 'Nonmember Physician' option. Note that there is no charge for members, but a fee of $33 applies for nonmembers.
3. If you are paying by credit card, fill in the payment details, including the type of card, amount, card number, expiration date, and name on the card. Ensure you include a billing address.
4. In Part 1, provide the delivery information, specifying the state licensing board where your profile should be sent. Remember to indicate whether you are an MD or DO.
5. In Part 2, complete your personal information, including your full name, date of birth, email address, social security number, medical education number (if applicable), and preferred mailing address. Be clear about whether your address is for your office, home, or another location.
6. In Part 3, input your medical education and other relevant details. Include your medical school of graduation, DEA number, year of graduation, ECFMG number, residency training information, hospital admitting privileges, and any group practice affiliations.
7. Sign the physician agreement section, understanding the release of liability regarding the accuracy of the information provided and the terms stated in the agreement.
8. Finally, save your changes and consider downloading or printing the completed form for your records. You can share it as needed.

Complete your Ama Profile online today to ensure your credentials are accurately represented.