First name *

Last name *

Email *

Phone *

Company name *

Company website *

Company type * Pharmaceutical Retail Pharmacy Digital Health Consumer Health Brand Health Insurance Plan Health System or Hospital Network Other not listed

Areas of interest * Patient EducationCaregiver EducationHCP EducationDirect to Patient ServicesLongitudinal Care Program Support ServicesSpecialty Services OnlyTechnology OnlyOther

What objectives are you aiming to achieve or challenges are you trying to overcome? *

Do you currently offer a live virtual care program? * Yes No In development

What best describes your current stage? * Replacing or expanding an existing vendor Scaling an active program Launching a new program Early exploration only

Current average monthly patient volume * <1,000 1,000-3,000 3,000-10,000 10,000+

Projected monthly volume within 12 months * <1,000 1,000-3,000 3,000-10,000 10,000+

States requiring clinician coverage * Single state Multi-state National (39-50 states)

Primary patient population * Adults (18+) Adolescents (12-18) Pediatrics (2-12) Multiple populations

Primary intervention type * Diagnosis & counseling only Prescription medications (retail pharmacy) Labs or diagnostics Combination of the above

Primary program type * Behavioral Health Condition-Based Care Convenience Care Dermatology Men’s Health Menopause Care Primary Care Sexual Health Urgent Care Weight Management Women’s Health Other Combination of the above

If applicable, what medication type will be offered for weight management? * Commercially available medications only Commercial and compounded medications Compounded medications only Not applicable

Target timeline to go live * 0-3 months 3-6 months 6-12 months Exploring only

Which range best reflects your expected year-one investment? * <$100k $100k-$200k $200k-$500k $500k+ Budget not yet defined

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