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Consultation Request
Request for Demo
Name of Organization
*
Name
*
First
Last
Job Title
*
Email
*
Phone Number
*
Address 1
*
Address 2
City
*
State
*
Zip code
*
Country
*
Do you have a pediatric service?
*
Yes
No
What conditions do think you do not have expertise to effectively diagnose or treat?
*
What other patient services do most providers need?
*
What specialty services do you think are best suited for telemedicine?
*
What other opportunities would your providers appreciate?
*
Second Opinion
Access to specialists
Training opportunities with Academic Medical Centers
Are there specialties that are offered on a limited basis due to capacity constraints?
*
What are your pediatric specialist needs?
*
Would you like a FREE telemedicine needs assessment?
*
Yes
No
Would you like a one month’s demo of the platform?
*
Yes
No
Additonal comments
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“Nothing beats a second set of eyes
on the lab-test results or MRI”
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