Telehealth Form – iVisitDoc

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Your Telehealth Appointment

iVisitdoc Telehealth Form

What's your weight loss goal?

Losing 1-15 lbs

Losing 16-50 lbs

Losing 51+ lbs

Not Sure, need to lose weight

First Name

Last Name

Gender

Male

Female

Other

Prefer not to say

Address

Address Line 1

Address Line 2

US States

City

Zip Code

What is your primary reason to contact us today?

Weight Management

Remote Patient Monitoring

Chronic Care Management

General Consultation

Prescription Refill

Follow-Up Appointment

New Symptoms / Health Concern

Insurance or Billing Question

Other

Is there anything else that you would like to let us know?

I consent to receive phone calls and SMS messages from iVisitDoc, and I have read and agree to the Terms and Conditions and Privacy Policy.

* By submitting, you agree to receive texts or calls from iVisitDoc (up to 2/day). Message/data rates may apply. Consent isn’t required for care or purchase. Reply STOP to opt out, HELP for help.*

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iVisitDoc, Inc.
7345 Woodland Drive Suite I
Indianapolis, IN 46278

Services

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Pay-Per-Visit
Weight Management

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Business
Virtual Primary Care
Resellers and TPA/PEO
Providers

Monitoring

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Diabetes Management
Blood Pressure Management
Diabetes Prevention Management
Health Tracker

iVisitDoc is a patient care platform that offers administrative and operational support to healthcare professionals who provide services through iVisitDoc’s telehealth system. iVisitDoc does not provide medical or pharmacy services and does not interfere with clinical decision-making. Payment does not guarantee the prescribing or dispensing of medication. The content on this website is for informational purposes only and should not replace professional medical advice, diagnosis, or treatment. If you have concerns about your health, please seek guidance from a qualified healthcare provider. This website is an advertisement for telehealth services, and any diagnosis, treatment, or prescription is determined solely by the prescribing clinician.

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