Is Telehealth Right for Me?! Quiz

1

What is Your First Name?

2

What is the problem you are currently having?* This field is required.Are you having increased concussion symptoms? Difficulty with your neurological disease? Is your teen demonstrating a change in behaviors or mood from a schedule change?

4

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

5

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

Yes

No

Other

6

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

Very Important

Important

Not Really Important

Unsure

7

What's the best email to send you your results?* This field is required.

example@example.com

8

What's your best phone number? * This field is required.

Area Code

Phone Number

9

10

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

Yes

No

Sometimes

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!