ModMed Research Panel Volunteer

Contact Information

Hi there! Thank you for your interest in design research at ModMed. Please fill out the below information for the client whom is interested in becoming a volunteer.

Question Title

1. Client First Name (Required.)

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2. Client Last Name (Required.)

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3. Email: Please provide a direct email address, rather than a general email address such as "info@practicename.com." These emails will be used only for research with ModMed's UX team. (Required.)

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4. Job Title

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5. Primary Job Function

Executive Leadership

Practice Administration or Other Management

Financial - patient claims and billing

Office staff

Clinical support staff

Clinical provider (MD, DO, PA, NP)

Question Title

* 1. Client First Name (Required.)

Question Title

* 2. Client Last Name (Required.)

Question Title

* 3. Email: Please provide a direct email address, rather than a general email address such as "info@practicename.com." These emails will be used only for research with ModMed's UX team. (Required.)

Question Title

* 4. Job Title

Question Title

* 5. Primary Job Function

1. Client First Name (Required.)

2. Client Last Name (Required.)

3. Email: Please provide a direct email address, rather than a general email address such as "info@practicename.com." These emails will be used only for research with ModMed's UX team. (Required.)

4. Job Title

5. Primary Job Function