Is Telehealth Right for Me Quiz - Telehealth Pipeline Template

1

Where does it hurt or where is the problem?* This field is required.

3

What is this pain or problem keeping you from doing? * This field is required.

4

Do you access to a computer or mobile device with video?* This field is required.

Yes

No

5

Do you have a limited ability to travel or just feel more comfortable having your health needs taken care of at home?* This field is required.

Yes

No

Sometimes

6

Do you have enough space to fully extend your arms from your sides* This field is required.

Yes

No

Sometimes

7

How important is it to solve this issue* This field is required.

Very Important

Important

Not Really Important

Unsure

8

Please enter the information below:* This field is required.

First Name

Last Name

9

Enter your Info to get your instant results* This field is required.

example@example.com

10

Calculation

11

CONGRATULATIONS! TELEHEALTH SEEMS LIKE A GREAT FITWe'll reach out to you shortly to see what questions you have about starting telehealth!

12

Telehealth May Work For YouWe'll reach out to you shortly to see what questions you have about starting Telehealth!