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APPLICATION POTENTIAL RECIPIENT INFORMATIONName:___Email Address:___ Relationship to Recipient:___Address:___Home Phone:___ Cell Phone:___Potential Recipients Name:___Age:___Recipients Needs:____________Primary
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Begin by creating an account with the virtual health care provider.
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Who needs virtual health care for?

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Individuals who are unable to physically visit a healthcare provider due to mobility issues or distance.
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Virtual health care is for providing medical services remotely using technology such as video conferencing or messaging apps.
Health care providers who offer virtual medical services are required to file virtual health care forms.
Virtual health care forms can be filled out online or through specific software provided by the healthcare provider.
The purpose of virtual health care is to increase access to medical services for patients who may not be able to visit a healthcare facility in person.
Information such as patient demographics, medical history, consultation notes, and treatment plans must be reported on virtual health care forms.
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