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Consultation Signup
How many
providers
from your organization would be using Blink Session? (not including admin users)*
-Select-
1
2
3-5
6-9
10-19
20+
How many
clients
(patients, students) is your organization currently seeing online?*
-Select Number-
None - Just Starting
10 or less
11-99
100-500
500+
What is the status of your company's telehealth program?*
Initial Research (No Budget Allocated)
Planning Phase (Budget Allocated)
In Production (Already Providing Telehealth Services)
Select ALL services you do or will provide via telehealth*
Speech Language Pathology
Occupational Therapy
Applied Behavior Analysis
Counseling or Psychotherapy
Physical Therapy
Visits with a MD, DO, NP, PA
Other
What type of company are you*
Outpatient Clinic
k-12 School/District
Inpatient Facility
Staffing Company
Other
Do you have a program to train your providers in teleheath?*
Yes
No
Yes but we are looking to change or expand
NOTICE: We are focused on your company's telehealth success. Because of this, typically training and or consulting is required beyond our platform's monthly subscription fee.
I Understand
Organization/Company Name*
First Name*
Last Name*
Your Company Email Address*
Please enter your company email address, not your personal address.
Phone*
Your location*
Select your role(s) in the company*
Director/Manager/Exec
IT
Provider
Other
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