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Personal Information

1/8

Full Name *Contact Information (Email or Phone Number) *Linkedin URL *

Specialisation and Experience

2/8

Area of Specialisations (Psychiatry, Dermatology, etc.) *Number of Years Practising *Do You Have Previous Experience with Telemedicine/Online Consultations *

None1-5 years5-10 years> 10 years

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Education and Credentials

3/8

Medical School Attended *Residency Training *Board Certifications *

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Availability

4/8

Days and Hours of Availability for Consultations *Flexibility for Urgent Consultations or Follow-up Appointments *

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Technical Proficiency

5/8

Comfort level with using technology for video consultations *Experience with specific telemedicine platforms or software *

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Languages Spoken

6/8

Are you fluent in other languages than English? *

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Attach a copy of CV

7/8

Please attach your CV *

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Additional Information

8/8

Any additional information you believe is relevant to your application

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