Practitioner Form: Professional Page Info

Welcome to TeleWeCure Practitioner Data Entry Form

Please answer all the fields accurately. We will use the data from this form to create professional pages for you and your practice.

We may slightly edit this name if necessary
If licensed in more than one province/state, select the main one.
What is your profession?
Which specialty?
In what languages can you communicate with patients efficiently?
What are your main areas of expertise/interest
Types of services you can provide (you can select both)

Visit Price (Canadian)

Check all time slots that you are available for online visits.
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
8-9 AM
9-10 AM
10-11 AM
11-12 AM
12-1 PM
1-2 PM
2-3 PM
3-4 PM
4-5 PM
5-6 PM
6-7 PM
7-8 PM
8-9 PM
9-10 PM
10-11 PM
11-12 PM
How many locations (clinics/offices) do you work at?
Address of location (clinic/office) 1
Address of location (clinic/office) 1
City
State/Province
Zip/Postal
Country
This field is not required but will be helpful for your potential patients

Maximum file size: 1MB

Uploading a cover image is not mandatory but it is very recommended. If you don't have a ready image, you can do this later from your TeleWeCure Business Dashboard. Recommended size: 1200x400 pixels
Address of location (clinic/office) 2
Address of location (clinic/office) 2
City
State/Province
Zip/Postal
Country
This field is not required but will be helpful for your potential patients

Maximum file size: 1MB

Uploading a cover image is not mandatory but it is very recommended. If you don't have a ready image, you can do this later from your TeleWeCure Business Dashboard. Recommended size: 800x400 pixels

Maximum file size: 1MB

Best dimension: 300x300