• Please answer the following questions:

  • * indicates a required field

  • Do you have a smartphone (iPhone or Android), tablet, or computer?*
  • Do you use email?*
  • Do you communicate with family and friends using email or text?*
  • Have you ever used technology to communicate with your health care provider?*
  • Do you trust the technology?*
  • Are there other barriers or challenges you have that prevent you from accessing telehealth services?
  • What are they? Check all that apply.*

  • Please provide your email address and mobile phone number to receive plan communications.

  • Format: (000) 000-0000.
  • Should be Empty: