We Build, Launch, and Scale Telehealth Clinics

Integraide Customer Intake

The Trusted Qualiphy Integration Partner

Please take 10-15 minutes to complete the form below. Answer all fields to the best of your ability.

Address

Street Address *

City *

State *

Country *

Postal Code *

Do you need a HIPAA-compliant CRM with sales pipeline, automated SMS and emails (payments, refills, stale leads, patient follow-ups)? *

It is highly recommended that you have a CRM and/or an EHR where you manage your patients if you are a clinic providing medical services or if you would like to access customer informaiton to market to. If you are not a clinic holding internal lisences and without access to PHI you may not need a CRM and/or EHR.

Do you have a medical director? *

A medical director is required to access Protected Health Information (PHI) and is an additional expense agreed upon between the clinic and the director. Medical oversight can range from hundreds to several thousand dollars monthly. By choosing to use our clinical team when selecting "No, I want to use your team" you understand that you are not recognized as the clinic for the patient of record until you obtain a license and manage medical oversight for patients receiving treatments in a given state. You will be compensated for your sale of access to medical treatment, not for the treatment itself.