Cedars-Sinai International

Question Title

* 1. Please provide below contact information

Name

Email Address

Question Title

* 2. Please provide the specialty/department/division

Question Title

* 3. Do you currently have any international professional engagements, affiliations, collaborations, etc.?

NO

YES, Please describe

Question Title

* 4. Would you be willing to participate in Cedars-Sinai International projects and engagements?

(Engagements include, but not limited to: training international doctors at Cedars-Sinai, visiting centers abroad, lectures at global conferences, consultation on program development, medical and academic collaboration with international institutions)

YES (INCLUDING TRAVEL)

YES (NO TRAVEL)

NO

Question Title

* 5. Would you be willing to be part of the Cedars-Sinai International Telehealth initiative?

(Will be strictly Doctor-to-Doctor communication via telehealth with contracted healthcare institutions internationally. Includes asynchronous eConsults and synchronous Video Consults.)

YES

NO

Question Title

* 6. Are you licensed to practice medicine in any country outside U.S.?

NO

YES, (please specify which Countries)

Question Title

* 7. Do you proficiently speak any languages other than English?

NO

YES (please specify which Languages)