PERSONAL INFO

Now interviewing Nurse Practitioners in 5 States (more states coming soon): Please allow 5 business days for a response.


Legal Name & Designation(Required)
Preferred Name(Required)
MM slash DD slash YYYY
Please enter a valid phone number.
Home Address(Required)
Certifications(Required)
Click plus to add more than 1
 
State(s) with Active License to Practice (select all that apply)(Required)
These are the states where Mindi currently offers telehealth. More states coming soon.
Do you have the authority to write scripts?(Required)
Do you have a current sponsoring or supervising MD?(Required)
Are you credentialed with?

EXPERIENCE


Are you currently practicing medicine?(Required)
Are you currently employed as a W-2 employee?(Required)
Are you currently working as a contractor (1099)?(Required)
Is your malpractice insurance policy current?(Required)
Choose the Best Description(Required)

Do you have a home computer purchased within the last 10 years?(Required)
Do you have a working camera in or attached to a home computer?(Required)
Do you have a Wifi / Internet download & upload speed of 50 Mbps or higher? (check it on speedtest.com_(Required)
How do you typically manage your patient appointment schedule?(Required)

Tech Aptitude: What technologies below are you comfortable managing without training or support? (select all that apply)(Required)
Tech Challenges: For which technologies below would you need training? (select all that apply)(Required)

INTERESTS


What are your top 2 interests or reasons for pursuing telehealth? (please select only 2)(Required)
Are any of the following unattractive to you? (select all that apply)(Required)

AVAILABILITY


(examples: $1,500/month or $6,000/month)
MM slash DD slash YYYY
Where else have you seen or heard of Mindi? (select all that apply)(Required)
If referred by a Telehealth Provider on Mindi, please enter their name. (they will become your advocate)
Accepted file types: jpg, png, heic, Max. file size: 40 MB.
Accepted file types: pdf, doc, docx, Max. file size: 40 MB.
File types: *.pdf or *.doc or *.docx