Join Virtual Medical Group



Please provide us with the following information so that we can validate your licensing information and confirm patient availability in your local area.

 

Name:
Practice:
Address:

(including all States with a valid Medical License)

Work Phone:
FAX:
Email:
 

Please check spelling

What States are you licensed in?(Example: NC, FL, OR)

How many patient reports would you like to review per week? 

Are you more interested in the telephone network, internet, web cam or all?



Do you currently have a web site?      

URL:  

Please indicate the best manner of reaching you (email, pager, home phone, etc.)

The best time to call is:


Enter the image code :