Member Introduction

1
How Empower Sleep Works. Make sure you watch this before going to next steps. It will answer many questions you will have about our practice.
2
What is your name?* This field is required.
First Name
Last Name
3
What is your email address?* This field is required.
example@example.com
4
What is your phone number?* This field is required.
5
What is your LinkedIn?You can skip this if you do not have a LinkedIn
6
What is your primary specialty, where you train and when?* This field is required.Internal Medicine, Stanford, completed 2016
7
What gets you super excited about sleep medicine?* This field is required.1 paragraph
Huge
Large
Normal
Small
Ok
Ok
8
Where did you do your sleep medicine fellowship and when?* This field is required.i.e - UCLA, 2020
9
Any other secondary specialties?* This field is required.Pulmonary / Critical Care
10
How many years of experience do you have providing care via telemedicine?* This field is required.
11
Do you have prior experience working with a digital healthcare company or startup?* This field is required.
YESNO
12
How many U.S. state(s) are you actively licensed in?* This field is required.
13
Which U.S. state(s) are you licensed in?* This field is required.If more than 10 no need to list
Huge
Large
Normal
Small
Ok
Ok
14
Upload a video telling us about yourself and why you are interested in Empower Sleep. If there is no video in the application, you will not be considered.Keep it simple and be yourself. If you have any technical issues, email care@empowersleep.com
Drag and drop files here
Select files to upload
Max. file size: 10.6MB
Cancelof
15
Youtube
16
Upload your resume hereThis is not mandatory
Drag and drop files here
Select files to upload
Max. file size: 10.6MB
Cancelof
17
In the form of a video, share about yourself and why you are interested in Empower Sleep? If there is no video, the application will not be considered* This field is required. 3-5-minute video. Keep it simple and be yourself; you can also email Care@empowersleep.com
Drag and drop files here
Select files to upload
Cancelof
18
In the form of a YouTube video, share about yourself and why you are interested in Empower Sleep? If there is no video application will not be considered. If you dont feel comfortable uploading to TY you can Email to Care@empowersleep.comEnter the url a 3-5-minute unlisted (not private) YouTube video. Keep it simple and be yourself.
Enter YouTube URL of an unlisted (not private) video.
Should be Empty: