Practitioner Page: Info to build page (from data source: TeleWeCure Practitioners List)

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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.

Full Name (First and Last)

Nickname (username) that you want to be used to create your TeleWeCure account (by us)

We may slightly edit this name if necessary

Email address that you want to be used to create your TeleWeCure account (by us)

Country of practice

Which province/state are you licensed in?

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

Brain Disorders with Movement or Balance Problems

Spinal Cord Disorders

Peripheral Nerve Disorders

Bones, Joints, Muscle, Spine problems

Disability of unknown cause

Cognitive Disorders

Obesity and other weight problems

Check as many as you want

Types of services you can provide (you can select both)

Online Visit

In-Person Visit

Health Service Providers (Insurance) that you accept for online visit

Which one is the faster way to reach you?

Email

Used for communications with TeleWeCure support

Phone number (strongly recommended to have WhatsApp on it)

Check all time slots that you are available for online visits.

Please provide a brief biography of yourself and your areas of expertise

Please upload a photo of yourself

Maximum file size: 1MB

Best shape: Square

Please upload a banner image for your home page (optional)

Maximum file size: 0.3MB

Best width to height ratio is 4:1

How many locations (clinics/offices) do you work at?

One location

Two locations

Work Places

Name of work place (clinic/office) (main work location)

Address of work place (clinic/office)

City

State/Province

Zip/Postal

Country

A brief description of location (clinic/office) 1

This field is not required but will be helpful for your potential patients

Upload a banner image for work place

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: 1200x300 pixels

Name of location (clinic/office) 2

Address of location (clinic/office) 2

City

State/Province

Zip/Postal

Country

A brief description of location (clinic/office) 2

This field is not required but will be helpful for your potential patients

Upload a banner image for location (clinic/office) 2

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: 1200x300 pixels

Main areas of expertise: 1

At least one of them should be in the field of disability rehabilitation.

Title of expertise 1

Brief description of expertise 1

Title of expertise 2

Brief description of expertise 2

Title of expertise 3

Brief description of expertise 3

Your Social Media addresses (Optional)

If you want to promote your social media, please put their addresses here

Youtube

Facebook

Instagram

URL of location 2 page

Captcha

Practitioner Page: Info to build page (from data source: TeleWeCure Practitioners List)

Work Places

Main areas of expertise: 1

Your Social Media addresses (Optional)

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