Add Telehealth Connect
Facility Name
Contact First Name
Contact Last Name
Contact Email
Secondary Contact Name
Secondary Contact Email
Website
Address
City
Select one
State
ZIP Code
Choose Setting Type
Setting Type
Choose General Specialties
Chronic Disease Management/Remote or Home Monitoring
Continuing/Provider Education
Health/Patient Education
Personnel Education
Nutritional counseling/Dietary services
General Specialties (where applicable)
Choose Population Based Screening Specialties
Colposcopy
Diabetic Retinopathy
Mammography
Population Based Screening Specialties (where applicable)
Choose Telemedicine Specialties
Asthma/Allergy/Immunology
Cardiology
Dentistry
Dermatology
eICU
Ear, Nose, and Throat
Emergency Medicine
Endocrinology
Gastroenterology
Genetics
Geriatrics
Hospice/Palliative Medicine
Infectious Disease
Nephrology
Neurology/Stroke
Oncology
Opthalmology
Orthopedics
Pathology
Pediatrics
Pharmacy
Primary Care/Family Medicine
Psychiatry/Mental Health
Pulmonology
Radiology
Surgery
Trauma
Telemedicine Specialties (where applicable)
Choose Telerehabilitation Specialties
Assistive Technology
Occupational Therapy
Physical Therapy
Speech Therapy
Telepsychiatry
Telerehabilitation Specialties (where applicable)
Choose Women's Health Specialties
Family Planning
Gynecology
Obstetrics
Perinatology
Women's Health Specialties (where applicable)
Choose One
Telehealth Services Provided?
Choose Site Type
Site Type
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