Provider Profile Update Form (for existing profiles only)

Before filling out this form, please check your provider profile on If any of your information is out of date or missing, please fill out the corresponding sections in this form. To schedule a new headshot, click here.

Please note, this form is only for existing provider profiles. If you have questions or you are a provider who sees patients and does not have a profile, please submit a ticket to the Digital team.

(You can use the NEPPES NPI Registry to find a provider’s NPI number)


This is the title you would use to describe yourself to your patient.
Example: Psychiatrist

This is your official BMC/BU title or the title you would use to describe yourself to your colleagues.
Director of Psychiatry Residency, Assistant Professor of Psychiatry

We strongly encourage you to provide us with a bio so your patients can get to know you better. Your professional bio can include your work, clinical interests, or anything you would like your patients and colleagues to know about you. (1,000 character limit)