Video Office Visit Questionnaire
We'd like to get your feedback regarding use of or interest in Video Office Visit technologies that allow for remote, real-time, face-to-face video encounters with your patients.
» Please enter your first and last name *
  (Maximum 1000 characters)
» What is your current role? *
  (Maximum 1000 characters)
» What is the name of your organization? *
  (Maximum 1000 characters)
» Where is the location of your main office? *
  (Maximum 1000 characters)
» How many office are there in your organization? *
» How many Care Providers (MDs, NPs, PAs) are there in your organization? *
  (Maximum 1000 characters)
» Please list all the specialties represented by your organization. *
(Maximum 1000 characters)
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Note : Questions marked with "*" character at the end are mandatory.
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