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MDTV Pediatric Telemedicine Follow-Up Survey


Practice Background Information
( Please complete categories below. )
Name: (required)
E-mail: (required)
Facility:
( Name/Address )
Please include all facilities in which you practice.

Physician Opinion
( Please complete categories below. )
Most referrals that I make to specialists could be handles using interactive telemedicine
I would be willing to refer to specialists in the telemedicine network if it were more convenient for my patients
I am willing to travel to another office in order for my patients to receive services through telemedicine
I would be more likely to refer patients for teleconsultation in non-physician providers could present the patient
I would be interested in participating in grand rounds or CME via MDTV videoconferencing

Additional Comments and Information:

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