Dialer for Free Clinics

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Dialer for Free Clinics - Intake Form

Hi there! 👋 Thank you for your interest in Dialer for Free Clinics.

We'd like to support the care you provide by offering complimentary access to Doximity's mobile telehealth service, Dialer Pro, to all free medical clinics in the United States.

📝 Please complete the intake form below, and a member of our team will reach out to you.

Contact's Name *

Contact's Email *

Free Clinic Name *

Website URL *

Total number of healthcare professionals who will need free Dialer Pro access *

Tax ID Number *

Before submitting, please confirm the following. *

We are a 100% free clinic

I have emailed our 501c3 documentation to dialerprofree@doximity.com

We will work with Doximity to share how we are using Dialer

Required

Please share how we can best support you.

I would like to learn how to best use Dialer in our clinic

I would like to speak with someone from the free clinic support team

Other:

Submit

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