Provider Signup CONTACT US NOW Learn how CareClix can bring telehealth to your business. Complete the form below and we'll be in touch soon.Please enable JavaScript in your browser to complete this form.Do you belong to a medical society?YesNoMedical Society *American Medical Association [AMA]American Medical Association [AMA]Administration on AgingAmerican Academy of Allergy Asthma & ImmunologyAmerican Academy of Child & Adolescent PsychiatryAmerican Academy of DermatologyAmerican Academy of Family PhysiciansAmerican Academy of NeurologyAmerican Academy of OphthalmologyAmerican Academy of Orthopaedic SurgeonsAmerican Academy of Pain MedicineAmerican Academy of PediatricsAmerican Academy of Physical Medicine & RehabilitationAmerican Association of Clinical EndocrinologistsAmerican Association of Colleges of Osteopathic MedicineAmerican Association of Electrodiagnostic MedicineAmerican Association of Neurological SurgeonsAmerican Board of Allergy & ImmunologyAmerican Board of Emergency MedicineAmerican Board of Family MedicineAmerican Board of Internal MedicineAmerican Board of Medical GeneticsAmerican Board of Medical SpecialtiesAmerican Board of Neurological SurgeryAmerican Board of Obstetrics and GynecologyAmerican Board of OphthalmologyAmerican Board of Orthopaedic SurgeryAmerican Board of OtolaryngologyAmerican Board of PathologyAmerican Board of PediatricsAmerican Board of Preventive MedicineAmerican Board of Psychiatry and NeurologyAmerican Board of RadiologyAmerican Board of SurgeryAmerican Cancer SocietyAmerican College of CardiologyAmerican College of Chest PhysiciansAmerican College of Emergency PhysiciansAmerican College of Obstetricians and GynecologistsAmerican College of PhysiciansAmerican College of Preventive MedicineAmerican College of RadiologyAmerican College of RheumatologyAmerican College of SurgeonsAmerican Heart AssociationAmerican Institute of Ultrasound in MedicineAmerican Neurological AssociationAmerican Osteopathic AssociationAmerican Psychiatric AssociationAmerican Roentgen Ray SocietyAmerican Society for Bariatric SurgeryAmerican Society for Dermatologic SurgeryAmerican Society for Gastrointestinal EndoscopyAmerican Society for Therapeutic Radiology and OncologyAmerican Society of Addiction MedicineAmerican Society of AnesthesiologistsAmerican Society of Cataract and Refractive SurgeryAmerican Society of Clinical OncologyAmerican Society of Internal MedicineAmerican Society of Ophthalmic Plastic and Reconstructive SurgeryAmerican Society of Plastic and Reconstructive SurgeonsAmerican Thoracic SocietyAmerican Urological AssociationCenters for Disease ControlCollege of American PathologistsCouncil of Medical Specialty SocietiesEndocrine Society, TheFederation of State Medical Boards of the United StatesNational Board of Medical ExaminersNational Cancer InstituteNational Council on the AgingNational Eye InstituteNational Heart, Lung, and Blood InstituteNational Hemophilia FoundationNational Institute of Allergy and Infectious DiseasesNational Institute of Arthritis and Musculoskeletal and Skin DiseasesNational Institute of Child Health and Human DevelopmentNational Institutes of HealthNational Institute on AgingNational Institute on Deafness and Other Communication DisordersNational Institute of Diabetes & Digestive & Kidney DiseasesNational Organization for Rare DisordersRadiological Society of North AmericaSociety for Investigative DermatologySociety of American Gastrointestinal Endoscopic SurgeonsSociety of Cardiovascular & Interventional RadiologySociety of Critical Care MedicineSociety of Nuclear MedicineSociety of Thoracic SurgeonsMedical Society of the State of New York LA County Medical AssociationMembership ID:What would you like to name your online clinic?ie: hopkins1800 (minimum of 4 characters, no spaces or special characters) What is your physical Clinic AddressAddress Line 1Address Line 2CityAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeWhat is the main point of contact's info *Phone NumberEmail *How many physicians would like to have in your clinic?Physician DetailsPhysician Name *FirstLastDOB *01/01/1970Email *Phone NumberAdminName *FirstLastDOB *01/01/1970Email *Phone NumberSubmitTotal$ 0.00Stripe Credit Card *CardName on CardTerms & ConditionsAgreement to terms & conditions Information AccuracyTo my knowledge, information provided is accurateSubmit
