Provider Telemedicine Interest Survey Question Title * 1. Tell us about yourself. Name: Specialty The best way to reach me is Phone number E-mail Address Question Title * 2. What city and state are you from? City State Question Title * 3. What conditions or diagnosis would you be willing to treat via telemedicine. Question Title * 4. What concerns you most about delivering healthcare via telemedicine? Question Title * 5. How soon would you like to get started? Within the next 6 months 6 months to a year from now Done