Telehealth Clinician Application

Join your fellow healthcare professionals on this exciting journey and finally get paid what you're worth!

Please ensure all of your information is accurate and complete. This will help with timely processing of your application so we can connect you with one of our practice experts.

Subject *

Your Name *

Professional Designation *

Board Certified *

Position of Interest *

Phone Number *

Your Email *

Practice Name

Street *

City *

State *

Zip *

Languages Spoken *

Total Available Hours Per Week *

Total State Licenses *

Individual NPI # *

Group NPI #

DEA #

I Am Credentialed with Medicare *

CAQH

PECOS

I Have My Own Malpractice Insurance *

I Have My Own Office *

I Offer Peptide Therapy *

I Found You Via *

My Priorty Is To

Additional Certifications and/or Information We Should Know *

Submit

Upon submission of your application, you will receive a link via text and/or email to book your qualifying call. Thank you for your interest in Turnkey Telehealth.