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Dallas Telehealth Client Registration

Business Name

Business Address

Business Telephone

Business Contact

Business Contact Job Title

Example: Owner|Office Manager|Marketing Manager|Etc

Email *

First Choice Medical Specialty*

Other Medical Specialty (If Applicable)

Your Marketing Information

Please add similar information to this script (adding your own information.) South Dallas Doctors. If you need to see a Pediatrician..contact the physicians at South Dallas Doctors. Call 000 000 0000 SouthDallasDoctors.com

Website or Webpage Link

Example - https://dallastelehealth.com/

Select Your Marketing Plan

Plan A - $0 First Three Months
Plan B - $0 First Three Months + $75. Per Month The Next Six Months (Nine Months Total)
Plan C - $0 First Three Months + $49. Per Month The Next Twelve Months (Fifteen Months Total)

Any plan can be cancelled with two weeks email notification at any time during the contract. Due to a limited number of vacancies...DallasTelehealth.com can not assure any business that Plan B or Plan C will be available at the end of their initial selection if a lower month plan is selected. It would be better to initially select Plan C and cancel with a two week notice if you choose not to continue.

Name

Dallas Telehealth Client Registration

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